MEDICARE: TERESA KYU THIN KHOO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician	A140938	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A140938	OTHER	CA	STATE LICENSE

General Provider Information

NPI Number	:	1114361813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA KYU THIN KHOO MD

Provider Business Mailing Address
First Line	:	18335 E VALLEY BLVD
Second Line	:
City	:	LA PUENTE
State	:	CA
Zip	:	91744-5968
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	18335 E VALLEY BLVD
Second Line	:
City	:	LA PUENTE
State	:	CA
Zip	:	91744-5968
Country	:	US
Telephone Number	:	714-547-7008
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2013
Last Update Date	:	01/12/2021

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