Healthcare Provider Details

I. General information

NPI: 1205758034
Provider Name (Legal Business Name): SARAH KHOURI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2026
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 N BELLFLOWER BLVD # 2-103
LONG BEACH CA
90840-0004
US

IV. Provider business mailing address

19726 KATHERINE CT
CERRITOS CA
90703-7429
US

V. Phone/Fax

Practice location:
  • Phone: 562-985-4051
  • Fax: 562-985-8067
Mailing address:
  • Phone: 562-781-3853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2255A2300X
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number390200000X
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: