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General NPI Number Information
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NPI Number | 1649765405
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Entity Type | Individual
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Provider Name | BRIAN KHONG DO
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Gender | Male
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Dates
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Enumeration Date | 06/25/2018
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Last Update Date | 11/15/2024
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Provider Practice Location Address
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Address Line | 3883 AIRWAY DR
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City | SANTA ROSA
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State | CA
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Zip | 95403-1670
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Country | US
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Telephone | 707-521-7735
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 276950
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City | SACRAMENTO
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State | CA
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Zip | 95827-6950
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Country | US
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Telephone | 707-521-7735
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 20A17575
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License Number State | CA
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