Provider Demographics
NPI:1982087185
Name:CHAU, KHANH NHAT (DMD)
Entity type:Individual
Prefix:
First Name:KHANH
Middle Name:NHAT
Last Name:CHAU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3640 HONEY GLEN WAY
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-0124
Mailing Address - Country:US
Mailing Address - Phone:408-313-1938
Mailing Address - Fax:
Practice Address - Street 1:3640 HONEY GLEN WAY
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-0124
Practice Address - Country:US
Practice Address - Phone:408-313-1938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64568122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist