Healthcare Provider Details

I. General information

NPI: 1881721306
Provider Name (Legal Business Name): ANN KEIKO JOHIRO MN, RN, FNP-BC, FNP-
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3756 SANTA ROSALIA DR SUITE 506
LOS ANGELES CA
90008-3606
US

IV. Provider business mailing address

3756 SANTA ROSALIA DR SUITE 506
LOS ANGELES CA
90008-3606
US

V. Phone/Fax

Practice location:
  • Phone: 323-617-5409
  • Fax: 323-544-6722
Mailing address:
  • Phone: 323-617-5409
  • Fax: 323-544-6722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4581
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number4581
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number270013
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number39468
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: