Healthcare Provider Details

I. General information

NPI: 1659351930
Provider Name (Legal Business Name): MARK KIM-LEON KHOO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25800 CARLOS BEE BLVD CSUEB STUDENT HEALTH SERVICES
HAYWARD CA
94542-3060
US

IV. Provider business mailing address

25800 CARLOS BEE BLVD CSUEB STUDENT HEALTH SERVICES
HAYWARD CA
94542-3060
US

V. Phone/Fax

Practice location:
  • Phone: 510-885-3735
  • Fax: 510-885-3230
Mailing address:
  • Phone: 510-885-3735
  • Fax: 510-885-3230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG67768
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: