Healthcare Provider Details

I. General information

NPI: 1568776532
Provider Name (Legal Business Name): SUSIE S K KAY M D A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2010
Last Update Date: 04/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 S SAN GABRIEL BLVD
SAN GABRIEL CA
91776-3117
US

IV. Provider business mailing address

1240 S SAN GABRIEL BLVD
SAN GABRIEL CA
91776-3117
US

V. Phone/Fax

Practice location:
  • Phone: 626-285-0185
  • Fax:
Mailing address:
  • Phone: 626-285-0185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA35778
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA35778
License Number StateCA

VIII. Authorized Official

Name: DR. SUSIE SAW-SIM KHOO KAY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 626-285-0185