MEDICARE: SARAH CHO KO PMHNP

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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	95004554	CA

General Provider Information

NPI Number	:	1336699933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH CHO KO PMHNP

Provider Business Mailing Address
First Line	:	3030 W OLYMPIC BLVD STE 217
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-6507
Country	:	US
Telephone Number	:	213-550-2159
Fax Number	:

Provider Business Practice Location Address
First Line	:	3030 W OLYMPIC BLVD STE 217
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-6507
Country	:	US
Telephone Number	:	213-550-2159
Fax Number	:	888-820-9903

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2016
Last Update Date	:	12/04/2020

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