Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | A63305 | CA |
N | 208D00000X | General Practice Physician | A63305 | CA |
NPI | 1003868027 |
---|---|
Provider Name | Dr. Bill J. Khoury |
First Address | Glendale, CA 91208-1442 |
Second Address | Glendale, CA 91208-1442 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 19/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003868027 | (05) | CA |
G86789 | (02) |