Healthcare Provider Details

I. General information

NPI: 1720613169
Provider Name (Legal Business Name): SABRINA KO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2020
Last Update Date: 03/05/2020
Certification Date: 03/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2895 LOMA VISTA RD STE D
VENTURA CA
93003-1527
US

IV. Provider business mailing address

1020 E BASTANCHURY RD
FULLERTON CA
92835-2782
US

V. Phone/Fax

Practice location:
  • Phone: 805-648-5143
  • Fax:
Mailing address:
  • Phone: 714-672-9445
  • Fax: 714-672-9448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA8603
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: