Provider Demographics
NPI:1114250735
Name:KHOURY, VIVIAN SAMI (DMD)
Entity Type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:SAMI
Last Name:KHOURY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 WESTLAKE CTR STE 330
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-1443
Mailing Address - Country:US
Mailing Address - Phone:650-758-4632
Mailing Address - Fax:650-758-4565
Practice Address - Street 1:341 WESTLAKE CTR STE 330
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-1443
Practice Address - Country:US
Practice Address - Phone:650-758-4632
Practice Address - Fax:650-758-4565
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-14
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA588291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice