Healthcare Provider Details

I. General information

NPI: 1679742779
Provider Name (Legal Business Name): CHUN-JU KAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 02/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 W CERRITOS AVE BLDG 8
ANAHEIM CA
92805-6549
US

IV. Provider business mailing address

2205 PAYTON
IRVINE CA
92620-3455
US

V. Phone/Fax

Practice location:
  • Phone: 714-254-8473
  • Fax: 714-254-8480
Mailing address:
  • Phone: 714-931-7222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF53249
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: