Gary Khammahavong, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

A175022 Issued in CA

Practice address

15107 Vanowen St
Van Nuys, CA 91405-4542

Phone

(818) 782-6600

NPI assigned

Apr 9, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

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

Specialty

Emergency Medicine

Education

Warren Alpert Medical School of Brown University, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Emergency Physicians Associates San Jose PCGroup PAC ID 8921344292, 131 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Santa Clara Valley Medical Center Hospital, San Jose, CA, CCN 050038

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: gkhammahavong194292@santaclaravalley.direct-ci.net

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.

• Emergency Physicians Associates San Jose PC

  • Emergency Medicine Physician
  • San Jose, CA
  • NPI 1306311576
  Medicare reassignment Care Compare group NPD
• County of Santa Clara

  dba SCVMC Physician Services

  • Anesthesiology Physician
  • San Jose, CA
  • NPI 1588721500

  Emergency Medicine

  Medicare reassignment NPD
• County of Santa Clara

  dba Valley Health Center Alexian

  • Federally Qualified Health Center (FQHC)
  • San Jose, CA
  • NPI 1629301346
  Medicare reassignment NPD
• County of Santa Clara

  dba Josefina Narvaez Mental Health Center MH Aoa

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • San Jose, CA
  • NPI 1699885079
  Medicare reassignment NPD
• Gem Medical Group Corporation

  • Emergency Medicine Physician
  • Whittier, CA
  • NPI 1689364721
  Medicare reassignment NPD
• Hollywood Presbyterian Emergency Medical Associates, Inc.

  • Emergency Medicine Physician
  • Los Angeles, CA
  • NPI 1972826931
  Medicare reassignment NPD
• Pacifica Emergency Medical Associates

  • Emergency Medicine Physician
  • Encino, CA
  • NPI 1053350975
  Medicare reassignment NPD
• Valley Presbyterian Emergency Medical Associates

  • Emergency Medicine Physician
  • Van Nuys, CA
  • NPI 1033133103
  Medicare reassignment NPD
• County of Santa Clara

  dba Valley Health Center Lundy

  • Federally Qualified Health Center (FQHC)
  • San Jose, CA
  • NPI 1043354020
  NPD
• County of Santa Clara

  dba Valley Health Center Milpitas

  • Federally Qualified Health Center (FQHC)
  • Milpitas, CA
  • NPI 1285629899
  NPD
• County of Santa Clara

  dba SCVMC Outpatient Pharmacy

  • Pharmacy
  • San Jose, CA
  • NPI 1891871919
  NPD
• Gem Medical Group Corporation

  dba GEM Medical Group

  • Emergency Medicine Physician
  • Monterey Park, CA
  • NPI 1689386815
  NPD

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

• County of Santa Clara

  dba Inpatient Acute/Outpatient Facility Services

  • General Acute Care Hospital
  • San Jose, CA
  • NPI 1063406551
  Care Compare affiliation

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

{
    "created_epoch": "1523232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646179200000",
    "number": "1760989636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "185 39TH ST APT D104",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152013235",
            "telephone_number": "401-345-0995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15107 VANOWEN ST",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914054542",
            "telephone_number": "818-782-6600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAMMAHAVONG",
        "first_name": "GARY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-09",
        "last_updated": "2022-03-02",
        "certification_date": "2022-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "PA",
            "license": "MD474559",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "A175022",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen Gary Khachatryan
• Khachikyan Health Services Inc
• Leila Khajehmolaei, PHARMACIST
• Nina Khakpour, LMFT
• Alice Khalil
• Imaan Khan
• Nabila Khan
• Zeevan M Khandaker
• Harout Khanjian, O.D.
• Lily Khanzetyan, RPH

• Emergency Medicine Physician in Van Nuys, CA
• Providers in Van Nuys, CA by specialty
• Emergency Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2022; 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.