Healthcare Provider Details

I. General information

NPI: 1932293560
Provider Name (Legal Business Name): MAUREEN O KHOO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 06/24/2020
Certification Date: 06/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 VAN NESS AVE
SAN FRANCISCO CA
94109-6978
US

IV. Provider business mailing address

320 DARDANELLI LANE, SUITE 20B
LOS GATOS CA
95032
US

V. Phone/Fax

Practice location:
  • Phone: 415-600-5760
  • Fax: 415-369-1389
Mailing address:
  • Phone: 408-364-2440
  • Fax: 408-374-3085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG83835
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number626786
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: