Healthcare Provider Details

I. General information

NPI: 1215258785
Provider Name (Legal Business Name): JA JAUNG KOO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2010
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 S WESTERN AVE
LOS ANGELES CA
90005-3024
US

IV. Provider business mailing address

311 S GRAMERCY PL UNIT 304
LOS ANGELES CA
90020-4590
US

V. Phone/Fax

Practice location:
  • Phone: 323-383-6207
  • Fax: 323-939-9304
Mailing address:
  • Phone: 323-892-7711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number60875
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: