Provider Demographics
NPI:1174833313
Name:KO, NA-HYEON (PT, PHD)
Entity Type:Individual
Prefix:
First Name:NA-HYEON
Middle Name:
Last Name:KO
Suffix:
Gender:F
Credentials:PT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6094 FULLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-2333
Mailing Address - Country:US
Mailing Address - Phone:646-330-3444
Mailing Address - Fax:
Practice Address - Street 1:2700 N MAIN ST
Practice Address - Street 2:SUITE 945
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-6634
Practice Address - Country:US
Practice Address - Phone:714-542-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031330-12251P0200X
CA397512251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics