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1194901173
KHAMPHA THEPHAVONG
FRESNO, CA
NPI
1194901173
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
207R00000X Internal Medicine
(Licence: CA 20A9790)
Enumeration Date
2008-01-21
Last Update Date
2020-08-05
Business Address
KHAMPHA THEPHAVONG D.O
2823 FRESNO ST
FRESNO, CA 93721-1324
Phone number: 559-459-6000
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Mailing Address
KHAMPHA THEPHAVONG D.O
5068 E HOME AVE
FRESNO, CA 93727-1948
Phone number: 805-234-0871
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