Provider Demographics
NPI:1891815080
Name:KHOO, SAM (PA)
Entity type:Individual
Prefix:
First Name:SAM
Middle Name:
Last Name:KHOO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 790
Mailing Address - Street 2:650 ZEDIKER AVE.
Mailing Address - City:PARLIER
Mailing Address - State:CA
Mailing Address - Zip Code:93648-0790
Mailing Address - Country:US
Mailing Address - Phone:559-646-6618
Mailing Address - Fax:559-646-6614
Practice Address - Street 1:476 E. WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:EARLIMART
Practice Address - State:CA
Practice Address - Zip Code:93219
Practice Address - Country:US
Practice Address - Phone:661-849-2638
Practice Address - Fax:661-849-5719
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13943363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA13943OtherCA PA LIC#