Individual
KHOA VO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
990 LAKE HUNTER CIR, SUITE 1A, MT PLEASANT, SC 29464-5426
(843) 881-4117
(843) 881-4155
Mailing address
990 LAKE HUNTER CIR, SUITE 1A, MT PLEASANT, SC 29464-5426
(843) 881-4117
(843) 881-4155
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
24892
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
055804
LICENSE
GA
01
—
24892
LICENSE
SC
05
—
248921
—
SC
Enumeration date
04/21/2006
Last updated
08/15/2013
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