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General NPI Number Information
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NPI Number | 1881575983
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Entity Type | Organization
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Legal Business Name | ELIAS N KHOURY DMD INC
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Dates
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Enumeration Date | 09/08/2025
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | 2515 S WESTERN AVE STE 109
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City | SAN PEDRO
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State | CA
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Zip | 90732-4643
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Country | US
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Telephone | 310-832-2657
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Fax | 310-308-8083
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Provider Business Mailing Address
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Address Line | 2515 S WESTERN AVE STE 109
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City | SAN PEDRO
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State | CA
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Zip | 90732-4643
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Country | US
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Telephone | 310-832-2657
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Fax | 310-308-8083
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. ELIAS KHOURY
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Credential | DMD
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Telephone | 310-832-2657
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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