Healthcare Provider Details

I. General information

NPI: 1871326959
Provider Name (Legal Business Name): LISA KHANG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2024
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4446 US HIGHWAY 220 N STE E
SUMMERFIELD NC
27358-9415
US

IV. Provider business mailing address

4446 US HIGHWAY 220 N STE E
SUMMERFIELD NC
27358-9415
US

V. Phone/Fax

Practice location:
  • Phone: 336-652-0080
  • Fax:
Mailing address:
  • Phone: 336-652-0080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: