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General NPI Number Information
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NPI Number | 1568805349
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Entity Type | Organization
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Legal Business Name | MICHAEL KHOURY OD INC
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Dates
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Enumeration Date | 04/11/2013
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Last Update Date | 07/27/2015
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Provider Practice Location Address
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Address Line | 6100 SEPULVEDA BLVD
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City | VAN NUYS
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State | CA
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Zip | 91411-2503
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Country | US
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Telephone | 818-373-0212
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Fax | 818-376-1212
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Provider Business Mailing Address
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Address Line | 6100 SEPULVEDA BLVD
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City | VAN NUYS
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State | CA
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Zip | 91411-2503
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Country | US
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Telephone | 818-373-0212
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Fax | 818-376-1212
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL KHOURY
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Credential | OD, MBA
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Telephone | 818-373-0212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 10204TPG
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License Number State | CA
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