Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A148459 | CA |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | A148459 | CA |
NPI | 1568849065 |
---|---|
Provider Name | Teresa Khoo |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Los Angeles, CA 90095-8358 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2015 |
Last Update Date | 02/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A148459 | STATE LICENSE (01) | CA |
FK7439258 | DEA (01) | CA |