Healthcare Provider Details

I. General information

NPI: 1063802437
Provider Name (Legal Business Name): TRUDY KAO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2015
Last Update Date: 02/24/2022
Certification Date: 02/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 W 34TH ST
LOS ANGELES CA
90089-3505
US

IV. Provider business mailing address

1000 S. FREMONT AVE UNIT 22 BUILDING A6, 4TH FL, RM 6436
ALHAMBRA CA
91803
US

V. Phone/Fax

Practice location:
  • Phone: 213-740-9355
  • Fax: 213-740-4961
Mailing address:
  • Phone: 213-740-9355
  • Fax: 213-740-4961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP016513
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95001819
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: