Individual
KHAMPHO THAMMAVONGXAY OHNO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
388 YPAO RD, TAMUNING, GU 96913-3701
(761) 646-8881
Mailing address
388 YPAO RD, TAMUNING, GU 96913-3701
(761) 646-8881
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA 60250454
WA
363AM0700X
Medical Physician Assistant
Primary
PA-84
GU
Other
Enumeration date
10/20/2011
Last updated
12/03/2020
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