Healthcare Provider Details

I. General information

NPI: 1891815080
Provider Name (Legal Business Name): SAM KHOO P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

476 E. WASHINGTON STREET
EARLIMART CA
93219
US

IV. Provider business mailing address

PO BOX 790 650 ZEDIKER AVE.
PARLIER CA
93648-0790
US

V. Phone/Fax

Practice location:
  • Phone: 661-849-2638
  • Fax: 661-849-5719
Mailing address:
  • Phone: 559-646-6618
  • Fax: 559-646-6614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA13943
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: