Basic Information
| Provider Information | |||||||||
| NPI: | 1891815080 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KHOO | ||||||||
| FirstName: | SAM | ||||||||
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| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 790 | ||||||||
| Address2: | 650 ZEDIKER AVE. | ||||||||
| City: | PARLIER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936480790 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596466618 | ||||||||
| FaxNumber: | 5596466614 | ||||||||
| Practice Location | |||||||||
| Address1: | 476 E. WASHINGTON STREET | ||||||||
| Address2: | |||||||||
| City: | EARLIMART | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6618492638 | ||||||||
| FaxNumber: | 6618495719 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA13943 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | PA13943 | 01 | CA | CA PA LIC# | OTHER |