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NPI Code Detail

MEDICARE: ERA KO

MEDICARE: ERA KO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker113498CA

General Provider Information

NPI Number : 1164060406
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERA KO
Provider Business Mailing Address
First Line : 14382 RED HILL AVE APT 10
Second Line :
City : TUSTIN
State : CA
Zip : 92780-6266
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 501 THE CITY DR S
Second Line :
City : ORANGE
State : CA
Zip : 92868-3305
Country : US
Telephone Number : 949-751-9143
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/17/2019
Last Update Date : 08/08/2024

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Directions to “ ERA KO ” Practice Location

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