Provider Demographics
NPI:1669485231
Name:KHOO, NINA C (MD)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:C
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 1:600 N GARFIELD AVE
Mailing Address - Street 2:106
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-1166
Mailing Address - Country:US
Mailing Address - Phone:626-280-9535
Mailing Address - Fax:626-280-1803
Practice Address - Street 1:600 N GARFIELD AVE
Practice Address - Street 2:106
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1166
Practice Address - Country:US
Practice Address - Phone:626-280-9535
Practice Address - Fax:626-280-1803
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20FRN0300X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A316640Medicaid
CAA84247Medicare UPIN
CAA31664Medicare ID - Type Unspecified