Healthcare Provider Details

I. General information

NPI: 1396939526
Provider Name (Legal Business Name): KHAI DO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 E 4TH ST STE 104
SANTA ANA CA
92705-3912
US

IV. Provider business mailing address

9880 CENTRAL AVE
MONTCLAIR CA
91763-2817
US

V. Phone/Fax

Practice location:
  • Phone: 909-621-3012
  • Fax: 909-621-3015
Mailing address:
  • Phone: 909-621-3012
  • Fax: 909-621-3016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA42932
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: