Provider Demographics
NPI:1255475299
Name:KHOURY, JOHNNY MICHEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:MICHEL
Last Name:KHOURY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3155D SEDONA CT
Mailing Address - Street 2:STE 100
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-6555
Mailing Address - Country:US
Mailing Address - Phone:909-698-9780
Mailing Address - Fax:
Practice Address - Street 1:7521 W LAKE MEAD BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0274
Practice Address - Country:US
Practice Address - Phone:702-804-5556
Practice Address - Fax:702-804-1635
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV12179207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
686856Medicare UPIN