Healthcare Provider Details

I. General information

NPI: 1558735720
Provider Name (Legal Business Name): KHOO WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2015
Last Update Date: 11/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8338 COMANCHE RD NE
ALBUQUERQUE NM
87110-2304
US

IV. Provider business mailing address

8338 COMANCHE RD NE
ALBUQUERQUE NM
87110-2304
US

V. Phone/Fax

Practice location:
  • Phone: 505-393-5556
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1182
License Number StateNM

VIII. Authorized Official

Name: MRS. LAN MILES
Title or Position: MANAGER
Credential:
Phone: 505-393-5556