Provider Demographics
NPI:1760093249
Name:SAM M. KHOURI, MD, A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:SAM M. KHOURI, MD, A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMI
Authorized Official - Middle Name:M
Authorized Official - Last Name:KHOURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-984-7870
Mailing Address - Street 1:1580 CREEKSIDE DR STE 260
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3889
Mailing Address - Country:US
Mailing Address - Phone:916-984-7870
Mailing Address - Fax:916-984-7871
Practice Address - Street 1:1580 CREEKSIDE DR STE 260
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3889
Practice Address - Country:US
Practice Address - Phone:916-984-7870
Practice Address - Fax:916-984-7871
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAM M. KHOURI, MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty