MEDICARE: MAUREEN ANN KHOO DDS

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	122300000X	Dentist	053584	NY

General Provider Information

NPI Number	:	1275723389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAUREEN ANN KHOO DDS

Provider Business Mailing Address
First Line	:	11 E BROADWAY
Second Line	:	13TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10038-1013
Country	:	US
Telephone Number	:	415-269-5203
Fax Number	:	212-227-3866

Provider Business Practice Location Address
First Line	:	11 E BROADWAY
Second Line	:	FLOOR 13
City	:	NEW YORK
State	:	NY
Zip	:	10038-1013
Country	:	US
Telephone Number	:	212-227-3088
Fax Number	:

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

Provider Enumeration Date	:	07/26/2007
Last Update Date	:	02/15/2014

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