Provider Demographics
NPI:1881767895
Name:KO, JOUNGHWA
Entity type:Individual
Prefix:
First Name:JOUNGHWA
Middle Name:
Last Name:KO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23930 LOS CODONA AVE
Mailing Address - Street 2:# 205
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5837
Mailing Address - Country:US
Mailing Address - Phone:310-378-1039
Mailing Address - Fax:
Practice Address - Street 1:3130 S HARBOR BLVD
Practice Address - Street 2:250
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-6824
Practice Address - Country:US
Practice Address - Phone:714-619-8777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 14651363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ07766Medicare UPIN