MEDICARE: NICOLA ELIAS KHOURY 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	35744	CA

General Provider Information

NPI Number	:	1861501520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLA ELIAS KHOURY DDS

Provider Business Mailing Address
First Line	:	266 N JACKSON AVE
Second Line	:	SUITE #3
City	:	SAN JOSE
State	:	CA
Zip	:	95116-1606
Country	:	US
Telephone Number	:	408-259-7900
Fax Number	:	408-259-1785

Provider Business Practice Location Address
First Line	:	266 N JACKSON AVE
Second Line	:	SUITE #3
City	:	SAN JOSE
State	:	CA
Zip	:	95116-1606
Country	:	US
Telephone Number	:	408-259-7900
Fax Number	:	408-259-1785

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

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	07/08/2007

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