Individual provider Active NPI

Khai DO, M.D.

  • Internal Medicine Physician
  • Santa Ana, CA
National Provider Identifier
1396939526
Registry record updated Jun 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A42932 Issued in CA
Practice address
2021 E 4TH St Ste 104
Santa Ana, CA 92705-3912
Phone
(909) 621-3012
Fax
(909) 621-3015
NPI assigned
Aug 30, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A42932 CA Primary

Addresses

Primary practice location

2021 E 4TH St Ste 104
Santa Ana, CA 92705-3912

Mailing address

9880 Central Ave
Montclair, CA 91763-2817
Phone (909) 621-3012

Other identifiers 1

IdentifierTypeStateIssuer
A42932OtherCALICENSE NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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

Enrollment IDStateProvider typePAC IDDetails
I20110505000300 CA Practitioner - Internal MedicinePractitioner - General Practice 7214112390 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: General Practice
Education
Louisiana State University School of Medicine in New Orleans, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Thien Phuoc Medical Center IncGroup PAC ID 6901296037, 2 clinicians

Practice addresses (Care Compare)

250 Hospital Cir
Westminster, CA 92683-3953
Phone (714) 373-0124

9880 Central Ave
Montclair, CA 91763-2817
Phone (909) 621-3012

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1333

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
42932CAMDPharmacist
A42932CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Thien Phuoc Medical Center Inc CurrentSince Mar 1, 2025 Accepting new patients
Pomona Valley Hospital Medical Center Past Accepting new patients
Crimson Medical Laboratories Inc Past Accepting new patients
San Antonio Regional Hospital Past Accepting new patients
Jason K Boutros M D Inc Internal Medicine PastSince Aug 28, 1996 Accepting new patients

Locations

250 Hospital Cir
Westminster, CA 92683
Phone (714) 890-6644

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: khai.do@bolsamg.directbygreenway.com

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1188432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782172800000",
    "number": "1396939526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9880 CENTRAL AVE",
            "city": "MONTCLAIR",
            "state": "CA",
            "postal_code": "917632817",
            "telephone_number": "909-621-3012",
            "fax_number": "909-621-3016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2021 E 4TH ST STE 104",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927053912",
            "telephone_number": "909-621-3012",
            "fax_number": "909-621-3015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DO",
        "first_name": "KHAI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-30",
        "last_updated": "2026-06-23",
        "certification_date": "2026-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A42932",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "A42932",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Ana, CA

Sources for this page

Verify at the official NPI Registry.