GARY KHAMMAHAVONG

VAN NUYS, CA
NPI1760989636
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy207P00000X Emergency Medicine
(Licence: CA  A175022)
Additional Taxonomies207P00000X Emergency Medicine
(Licence: PA  MD474559)
390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date2018-04-09
Last Update Date2022-03-02
Business Address
GARY KHAMMAHAVONG MD
15107 VANOWEN ST
VAN NUYS, CA 91405-4542
Phone number: 818-782-6600
Mailing Address
GARY KHAMMAHAVONG MD
185 39TH ST APT D104
PITTSBURGH, PA 15201-3235
Phone number: 401-345-0995