1386874964 NPI number — LARRY T KHOO MD INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386874964 NPI number — LARRY T KHOO MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LARRY T KHOO MD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
THE SPINE CLINIC OF LOS ANGELES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386874964
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1245 WILSHIRE BLVD STE 770
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90017-4810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
213-481-8500
Provider Business Mailing Address Fax Number:
213-481-8555

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1245 WILSHIRE BLVD
Provider Second Line Business Practice Location Address:
SUITE 717
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90017-4810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-481-8500
Provider Business Practice Location Address Fax Number:
213-481-8500
Provider Enumeration Date:
07/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
KHOO
Authorized Official First Name:
LARRY
Authorized Official Middle Name:
T
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
213-481-8500

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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