Provider Information for 1740838374
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JACQUELINE KO
Sex: Female
NPI: 1740838374
Last Updated: 2024-10-09
Certification Date: 2024-10-09
Certification Date: 2024-10-09
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1740838374 | ||||||||||||
| Enumeration Date | 2019-08-27 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | PO BOX 2461 CUPERTINO, CA 95015-2461 United States Phone: 650-204-0466 | Fax: | ||||||||||||
| Primary Practice Address | 2635 ZANKER RD SAN JOSE, CA 95134-2107 United States Phone: 408-292-9353 | Fax: | ||||||||||||
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