Healthcare Provider Details

I. General information

NPI: 1548755564
Provider Name (Legal Business Name): LORNA MARIE KHOO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2018
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 JEFFERSON BLVD STE B195
WEST SACRAMENTO CA
95605-2350
US

IV. Provider business mailing address

2810 35TH ST APT 211
SACRAMENTO CA
95817-2846
US

V. Phone/Fax

Practice location:
  • Phone: 916-403-2900
  • Fax:
Mailing address:
  • Phone: 415-867-2822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW90159
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: