Pennie Khong, NP | |
3505 Spangler Ln Ste 400, Copperopolis, CA 95228-9424 | |
(209) 785-7000 | |
Not Available |
Full Name | Pennie Khong |
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Gender | Female |
Speciality | Nurse Practitioner - Family |
Location | 3505 Spangler Ln Ste 400, Copperopolis, California |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
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1770192924 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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363LF0000X | Nurse Practitioner - Family | AP61090460 (Washington) | Primary |
Entity Name | Mark Twain Medical Center |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1508968819 PECOS PAC ID: 8820073711 Enrollment ID: O20061006000227 |
Mailing Address | Practice Location Address |
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Pennie Khong, NP 3505 Spangler Ln Ste 400, Copperopolis, CA 95228-9424 Ph: (209) 785-7000 | Pennie Khong, NP 3505 Spangler Ln Ste 400, Copperopolis, CA 95228-9424 Ph: (209) 785-7000 |
Sofia R. Bulahan, FNP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: Copperopolis Family Medical Clinic, 3505 Spangler Lane, Suite 400, Copperopolis, CA 95228 Phone: 209-785-7000 | |
Polly Chrysanthemum Dodds, Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 430 Sawmill Creek Rd Unit 6, Copperopolis, CA 95228 Phone: 209-785-7000 Fax: 209-785-7025 |