Provider Demographics
NPI:1265985824
Name:ELKHOURY, GHASSAN (LAC)
Entity type:Individual
Prefix:MR
First Name:GHASSAN
Middle Name:
Last Name:ELKHOURY
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7871 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-0471
Mailing Address - Country:US
Mailing Address - Phone:619-465-8800
Mailing Address - Fax:619-465-8808
Practice Address - Street 1:7871 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-0471
Practice Address - Country:US
Practice Address - Phone:619-465-8800
Practice Address - Fax:619-465-8808
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-01
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 10036171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist