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General NPI Number Information
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NPI Number | 1376177691
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Entity Type | Individual
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Provider Name | STEPHANIE SUN KOH FNP-C
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Gender | Female
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Dates
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Enumeration Date | 02/25/2020
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Last Update Date | 08/31/2023
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Provider Practice Location Address
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Address Line | 777 N RAINBOW BLVD STE 350
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City | LAS VEGAS
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State | NV
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Zip | 89107-1188
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Country | US
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Telephone | 833-208-0588
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Fax | 702-921-9712
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Provider Business Mailing Address
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Address Line | 3103 DAVID AVE
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City | PALO ALTO
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State | CA
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Zip | 94303-3944
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Country | US
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Telephone | 732-770-6484
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 826301
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License Number State | NV
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