| Pennie Khong, NP | |
|
3505 Spangler Ln Ste 400, Copperopolis, CA 95228-9424 | |
| (209) 785-7000 | |
| Not Available |
| Full Name | Pennie Khong |
|---|---|
| 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 |
|---|---|---|---|
| 1770192924 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363LF0000X | Nurse Practitioner - Family | AP61090460 (Washington) | Primary |
| Entity Name | Mark Twain Medical Center |
|---|---|
| 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 |
|---|---|
| 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 |