Basic Information
| Provider Information | |||||||||
| NPI: | 1255475299 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KHOURY | ||||||||
| FirstName: | JOHNNY | ||||||||
| MiddleName: | MICHEL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3155D SEDONA CT | ||||||||
| Address2: | STE 100 | ||||||||
| City: | ONTARIO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917646555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9096989780 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7521 W LAKE MEAD BLVD | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891280274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028045556 | ||||||||
| FaxNumber: | 7028041635 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2007 | ||||||||
| LastUpdateDate: | 03/05/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 12179 | NV | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.