Provider Demographics
NPI:1659351930
Name:KHOO, MARK KIM-LEON (MD)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:KIM-LEON
Last Name:KHOO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25800 CARLOS BEE BLVD
Mailing Address - Street 2:CSUEB STUDENT HEALTH SERVICES
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94542-3060
Mailing Address - Country:US
Mailing Address - Phone:510-885-3735
Mailing Address - Fax:510-885-3230
Practice Address - Street 1:25800 CARLOS BEE BLVD
Practice Address - Street 2:CSUEB STUDENT HEALTH SERVICES
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94542-3060
Practice Address - Country:US
Practice Address - Phone:510-885-3735
Practice Address - Fax:510-885-3230
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG67768207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G677680Medicaid
CA00G677680Medicaid