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General NPI Number Information
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NPI Number | 1851147185
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Entity Type | Individual
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Provider Name | MATTHEW KHUONG CAA
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Gender | Male
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Dates
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Enumeration Date | 04/26/2024
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Last Update Date | 05/07/2024
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Provider Practice Location Address
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Address Line | 2400 ROUND ROCK AVE
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City | ROUND ROCK
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State | TX
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Zip | 78681-4004
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Country | US
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Telephone | 512-341-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 228 MANZANITA DR
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City | MUSTANG RIDGE
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State | TX
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Zip | 78610-2594
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Country | US
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Telephone | 512-739-5120
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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 | 367H00000X
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Taxonomy Name | Anesthesiologist Assistant
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License Number |
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License Number State |
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