Healthcare Provider Details

I. General information

NPI: 1538694013
Provider Name (Legal Business Name): KOPRO HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2017
Last Update Date: 04/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 N GLASSELL ST SUITE B
ORANGE CA
92865-1078
US

IV. Provider business mailing address

2950 N GLASSELL ST SUITE B
ORANGE CA
92865-1078
US

V. Phone/Fax

Practice location:
  • Phone: 949-436-8521
  • Fax:
Mailing address:
  • Phone: 949-436-8521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC17316
License Number StateCA

VIII. Authorized Official

Name: MISS JEANNE GIN-JU KO
Title or Position: ACUPUNCTURIST
Credential: M.H.S, LAC.
Phone: 949-436-8521