Healthcare Provider Details

I. General information

NPI: 1427962190
Provider Name (Legal Business Name): JEMIE E SAE KOO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5545 OCEAN UNIT 106
HAWTHORNE CA
90250-1111
US

IV. Provider business mailing address

5545 OCEAN UNIT 106
HAWTHORNE CA
90250-1111
US

V. Phone/Fax

Practice location:
  • Phone: 424-290-1288
  • Fax:
Mailing address:
  • Phone: 424-290-1288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: