Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC13576 | CA |
NPI | 1003985680 |
---|---|
Provider Name | Dr. Antoine G Khoury |
First Address | Los Angeles, CA 90029-1748 |
Second Address | Los Angeles, CA 90029-1748 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
54126 | ASHP (01) | CA |
DC0135760 | BLUE SHIELD OF CALIFORNIA (01) | CA |