Healthcare Provider Details

I. General information

NPI: 1598015810
Provider Name (Legal Business Name): CATHERINE KO R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 09/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 W DUARTE RD SUITE 104
ARCADIA CA
91007-7617
US

IV. Provider business mailing address

650 W DUARTE RD SUITE 104
ARCADIA CA
91007-7617
US

V. Phone/Fax

Practice location:
  • Phone: 626-446-1740
  • Fax:
Mailing address:
  • Phone: 626-446-1740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1055191
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: