MEDICARE: COREEN KER HSIEN HUO DO

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207RN0300X	Nephrology Physician	20A16020	CA

General Provider Information

NPI Number	:	1932626553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COREEN KER HSIEN HUO DO

Provider Business Mailing Address
First Line	:	1505 WILSON TER STE 155
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91206-4032
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1505 WILSON TER STE 155
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91206-4032
Country	:	US
Telephone Number	:	818-500-4055
Fax Number	:

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

Provider Enumeration Date	:	08/24/2017
Last Update Date	:	12/08/2021

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