Healthcare Provider Details

I. General information

NPI: 1639035595
Provider Name (Legal Business Name): KRISTIANA NICOLE KOKER PPSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIANA KOKER HANSEN

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 W MISSION RD
ALHAMBRA CA
91803-1618
US

IV. Provider business mailing address

1754 S CABANA AVE
WEST COVINA CA
91790-4501
US

V. Phone/Fax

Practice location:
  • Phone: 626-943-3000
  • Fax:
Mailing address:
  • Phone: 323-895-0769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number220018679
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: