Healthcare Provider Details

I. General information

NPI: 1376841924
Provider Name (Legal Business Name): KAORI KAREN OKI LAI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAORI KAREN OKI

II. Dates (important events)

Enumeration Date: 03/07/2011
Last Update Date: 03/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 YOUTH WAY
FULLERTON CA
92835-3819
US

IV. Provider business mailing address

2050 YOUTH WAY
FULLERTON CA
92835
US

V. Phone/Fax

Practice location:
  • Phone: 949-892-8080
  • Fax:
Mailing address:
  • Phone: 949-892-8080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: