Healthcare Provider Details

I. General information

NPI: 1023101888
Provider Name (Legal Business Name): ADNAN ELIAS KHOURY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 09/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9449 SAN FERNANDO ROAD
SUN VALLEY CA
91352-1421
US

IV. Provider business mailing address

13351 RIVERSIDE DR BOX 233
SHERMAN OAKS CA
91423-2542
US

V. Phone/Fax

Practice location:
  • Phone: 818-421-4871
  • Fax: 818-907-9121
Mailing address:
  • Phone: 818-421-4871
  • Fax: 818-907-9121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberA68659
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberA68659
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084P0005X
TaxonomyNeurodevelopmental Disabilities Physician
License NumberA68659
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA68659
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA68659
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License NumberA68659
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: