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General NPI Number Information
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NPI Number | 1205145109
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Entity Type | Organization
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Legal Business Name | KHOI X DAM MD PA
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Dates
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Enumeration Date | 09/27/2010
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Last Update Date | 10/21/2010
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Provider Practice Location Address
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Address Line | 11915 OAK TRAIL WAY
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City | PORT RICHEY
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State | FL
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Zip | 34668-1064
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Country | US
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Telephone | 727-863-7995
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Fax | 727-868-4359
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Provider Business Mailing Address
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Address Line | 11915 OAK TRAIL WAY
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City | PORT RICHEY
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State | FL
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Zip | 34668-1064
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Country | US
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Telephone | 727-863-7995
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Fax | 727-868-4359
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Authorized Official
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Title or Position | PRESIDENT
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Name | KHOI XUAN DAM
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Credential | MD
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Telephone | 727-863-7995
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | ME32037
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License Number State | FL
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