Healthcare Provider Details

I. General information

NPI: 1043281066
Provider Name (Legal Business Name): PETER KHO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

644 NAPLES ST
CHULA VISTA CA
91911-1636
US

IV. Provider business mailing address

1525 LA CHICA DR
CHULA VISTA CA
91911-6953
US

V. Phone/Fax

Practice location:
  • Phone: 619-585-5555
  • Fax: 619-279-7910
Mailing address:
  • Phone: 619-585-5555
  • Fax: 619-427-7910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberA 36350
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: