Provider Demographics
NPI:1467678524
Name:KHOO, NYUNT TIN (MD)
Entity Type:Individual
Prefix:DR
First Name:NYUNT
Middle Name:TIN
Last Name:KHOO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1603 SILVER RAIN DR
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-3036
Mailing Address - Country:US
Mailing Address - Phone:909-396-1896
Mailing Address - Fax:
Practice Address - Street 1:2100 FOOTHILL BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-2905
Practice Address - Country:US
Practice Address - Phone:909-596-1941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48490208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF19074Medicare UPIN