Khanh Phuong DO, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

41464 Issued in OK

Practice address

3214 J D Kethley Rd
Shawnee, OK 74804-9625

Phone

(405) 395-5600

Fax

(405) 395-0852

NPI assigned

Apr 29, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Other, 2023

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: kdo453612@direct-ehr-ssmhc.com
• Direct secure messaging: khanh.do.1@17619.direct.athenahealth.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1588118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787011200000",
    "number": "1154942282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3214 J D KETHLEY RD",
            "city": "SHAWNEE",
            "state": "OK",
            "postal_code": "74804",
            "telephone_number": "405-395-5600",
            "fax_number": "405-395-0852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3214 J D KETHLEY RD",
            "city": "SHAWNEE",
            "state": "OK",
            "postal_code": "748049625",
            "telephone_number": "405-395-5600",
            "fax_number": "405-395-0852"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DO",
        "first_name": "KHANH",
        "middle_name": "PHUONG",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-29",
        "last_updated": "2026-08-18",
        "certification_date": "2026-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "41464",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mitchell Gene Deshazer
• Carol Ann Diamond, DPH
• Morgan Diaz
• David P Dickerson, D. C.
• Ronald Boe Dillman, LMSW-P
• Connie Dockrey
• Dallyn Shea Dooley
• Misty Michelle Douthit, M.ED, LPC
• Jessicca Lynne Downey, LPN
• Alice Kathryn Downing, ATC

• Family Medicine Physician in Shawnee, OK
• Providers in Shawnee, OK by specialty
• Family Medicine Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.