Healthcare Provider Details

I. General information

NPI: 1881626661
Provider Name (Legal Business Name): SOOCHUEN TRICIA KHO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 04/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S MOORPARK RD
THOUSAND OAKS CA
91361-1008
US

IV. Provider business mailing address

2876 SYCAMORE DR STE 303
SIMI VALLEY CA
93065-1550
US

V. Phone/Fax

Practice location:
  • Phone: 805-379-9646
  • Fax: 805-379-0611
Mailing address:
  • Phone: 805-379-9646
  • Fax: 805-379-0611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA79475
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: