Healthcare Provider Details

I. General information

NPI: 1942477054
Provider Name (Legal Business Name): EMILY JEAN OCHOA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY JEAN HORNER

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 BROADWAY BLVD STE 400
KANSAS CITY MO
64111-3342
US

IV. Provider business mailing address

901 E 104TH ST MAILSTOP 400
KANSAS CITY MO
64131
US

V. Phone/Fax

Practice location:
  • Phone: 816-932-4500
  • Fax: 816-932-4635
Mailing address:
  • Phone: 816-599-9499
  • Fax: 816-932-9670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number04-35668
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number2012013473
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: