Healthcare Provider Details

I. General information

NPI: 1669160255
Provider Name (Legal Business Name): KATHERINE JO ZOGG WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE JO NICKELS RN

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4455 W 117TH ST STE 200
HAWTHORNE CA
90250-2240
US

IV. Provider business mailing address

11500 W OLYMPIC BLVD STE 570
LOS ANGELES CA
90064-1536
US

V. Phone/Fax

Practice location:
  • Phone: 310-219-2000
  • Fax:
Mailing address:
  • Phone: 310-268-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number95024992
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: