Provider Demographics
NPI:1841246063
Name:KHOURY, SAMI E (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMI
Middle Name:E
Last Name:KHOURY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 51238
Mailing Address - Street 2:ATTENTION: MAGGIE NOLES
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-5538
Mailing Address - Country:US
Mailing Address - Phone:562-741-4461
Mailing Address - Fax:562-741-4413
Practice Address - Street 1:12900 PARK PLAZA DR STE 150
Practice Address - Street 2:ATTENTION: MAGGIE NOLES
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-9329
Practice Address - Country:US
Practice Address - Phone:562-741-4461
Practice Address - Fax:562-741-4413
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA35083207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A350830Medicaid
CAWA35083GMedicare PIN
CAA84732Medicare UPIN