Provider Demographics
NPI:1992881650
Name:KAY, SUSIE SAW-SIM KHOO (M D)
Entity type:Individual
Prefix:
First Name:SUSIE
Middle Name:SAW-SIM KHOO
Last Name:KAY
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 S SAN GABRIEL BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-3117
Mailing Address - Country:US
Mailing Address - Phone:626-285-0185
Mailing Address - Fax:626-285-0163
Practice Address - Street 1:1240 S SAN GABRIEL BLVD
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3117
Practice Address - Country:US
Practice Address - Phone:626-285-0185
Practice Address - Fax:626-285-0163
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35778208100000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
1568776532OtherNPI
CA00A357780Medicaid
A84811Medicare UPIN
CA00A357780Medicaid