Provider Demographics
NPI:1881626661
Name:KHO, SOOCHUEN TRICIA (MD)
Entity type:Individual
Prefix:
First Name:SOOCHUEN
Middle Name:TRICIA
Last Name:KHO
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 1:2876 SYCAMORE DR
Mailing Address - Street 2:STE 303
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-1550
Mailing Address - Country:US
Mailing Address - Phone:805-379-9646
Mailing Address - Fax:805-379-0611
Practice Address - Street 1:301 S MOORPARK RD
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-1008
Practice Address - Country:US
Practice Address - Phone:805-379-9646
Practice Address - Fax:805-379-0611
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79475207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00957562OtherMEDICARE RAILROAD
CAP00957562OtherMEDICARE RAILROAD
CAA79475Medicare PIN
CAES023ZMedicare PIN