MEDICARE: HOANG PHUONG KHANH DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	122300000X	Dentist	111763	CA
3	1223G0001X	General Practice Dentistry	42057	TX

General Provider Information

NPI Number	:	1164319562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOANG PHUONG KHANH DO

Provider Business Mailing Address
First Line	:	19035 TALAVERA RDG APT 4111
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78257-1490
Country	:	US
Telephone Number	:	626-464-2352
Fax Number	:

Provider Business Practice Location Address
First Line	:	7875 KITTY HAWK RD STE 102
Second Line	:
City	:	CONVERSE
State	:	TX
Zip	:	78109-1766
Country	:	US
Telephone Number	:	210-898-8845
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2025
Last Update Date	:	03/18/2026

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Directions to “ HOANG PHUONG KHANH DO ” Practice Location

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