Provider Demographics
NPI:1215186044
Name:BOAND, KATHERINE ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANN
Last Name:BOAND
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:ANN
Other - Last Name:DUFFY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS PA-C
Mailing Address - Street 1:444 S SAN VICENTE BLVD
Mailing Address - Street 2:STE 901
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-4174
Mailing Address - Country:US
Mailing Address - Phone:626-665-3169
Mailing Address - Fax:
Practice Address - Street 1:444 S. SAN VICENTE
Practice Address - Street 2:#900
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048
Practice Address - Country:US
Practice Address - Phone:310-248-7325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19917363A00000X, 363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical