Healthcare Provider Details

I. General information

NPI: 1679449417
Provider Name (Legal Business Name): JADYN KOSS OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2025
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 E COLORADO BLVD STE 100
PASADENA CA
91107-6617
US

IV. Provider business mailing address

240 NATURAL BRIDGE LN
PALMDALE CA
93551-3670
US

V. Phone/Fax

Practice location:
  • Phone: 626-564-2700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number28444
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: