Healthcare Provider Details

I. General information

NPI: 1154555878
Provider Name (Legal Business Name): KATIE K CHEON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2009
Last Update Date: 05/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 WILSHIRE BLVD
LOS ANGELES CA
90017-1901
US

IV. Provider business mailing address

1225 WILSHIRE BLVD
LOS ANGELES CA
90017-1901
US

V. Phone/Fax

Practice location:
  • Phone: 213-977-4123
  • Fax: 213-202-7211
Mailing address:
  • Phone: 213-977-4123
  • Fax: 213-202-7211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number17198
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: