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General NPI Number Information
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NPI Number | 1871054346
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Entity Type | Individual
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Provider Name | ANTOINE KENNETH KHOURY DO
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Gender | Male
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Dates
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Enumeration Date | 03/27/2019
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Last Update Date | 12/26/2023
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Provider Practice Location Address
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Address Line | 8536 WILSHIRE BLVD STE 102
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-3154
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Country | US
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Telephone | 310-248-7501
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Fax |
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Provider Business Mailing Address
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Address Line | 2160 S 1ST AVE
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City | MAYWOOD
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State | IL
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Zip | 60153-3328
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Country | US
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Telephone | 734-718-2716
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 125.074915
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 125.074915
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 20A20942
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License Number State | CA
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