Individual
GARY KHAMMAHAVONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
15107 VANOWEN ST, VAN NUYS, CA 91405-4542
(818) 782-6600
Mailing address
185 39TH ST APT D104, PITTSBURGH, PA 15201-3235
(401) 345-0995
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
A175022
CA
207P00000X
Emergency Medicine Physician
MD474559
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/09/2018
Last updated
03/02/2022
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