Healthcare Provider Details

I. General information

NPI: 1528271996
Provider Name (Legal Business Name): JANE S KHOUW D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 WALNUT AVE
SAN DIEGO CA
92103-4904
US

IV. Provider business mailing address

315 WALNUT AVE
SAN DIEGO CA
92103-4904
US

V. Phone/Fax

Practice location:
  • Phone: 619-297-2954
  • Fax: 619-297-2837
Mailing address:
  • Phone: 619-297-2954
  • Fax: 619-297-2837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number37430
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: