Provider Demographics
NPI:1821240938
Name:KHOURY, SHAHIRA (MD)
Entity Type:Individual
Prefix:
First Name:SHAHIRA
Middle Name:
Last Name:KHOURY
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 1:101 THE CITY DR S
Mailing Address - Street 2:BLDG 53 , RM B17
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3201
Mailing Address - Country:US
Mailing Address - Phone:714-456-6672
Mailing Address - Fax:714-456-6557
Practice Address - Street 1:101 THE CITY DR S
Practice Address - Street 2:BLDG 53.RMB17
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3201
Practice Address - Country:US
Practice Address - Phone:714-456-6672
Practice Address - Fax:714-456-6557
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC53416208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation