Healthcare Provider Details

I. General information

NPI: 1811552805
Provider Name (Legal Business Name): JENNIFER KUO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER KO NP

II. Dates (important events)

Enumeration Date: 05/05/2019
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

898 N PACIFIC COAST HWY STE 600
EL SEGUNDO CA
90245-2747
US

IV. Provider business mailing address

2090 WESTWOOD BLVD
LOS ANGELES CA
90025-6329
US

V. Phone/Fax

Practice location:
  • Phone: 310-375-2134
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95010349
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: