Healthcare Provider Details

I. General information

NPI: 1649134859
Provider Name (Legal Business Name): JASMINE KHUU NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 GREEN VALLET RD
FREEDOM CA
95019-3135
US

IV. Provider business mailing address

4829 W 132ND ST
HAWTHORNE CA
90250-5040
US

V. Phone/Fax

Practice location:
  • Phone: 831-728-2005
  • Fax: 831-728-3310
Mailing address:
  • Phone: 424-675-1757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN95299794
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: