Provider Demographics
NPI:1336470871
Name:KOCHAON, SANDRA M (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:SANDRA
Middle Name:M
Last Name:KOCHAON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:412 E COLORADO BLVD
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-2964
Mailing Address - Country:US
Mailing Address - Phone:626-607-7491
Mailing Address - Fax:626-338-3937
Practice Address - Street 1:910 S SUNSET AVE STE 8
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3409
Practice Address - Country:US
Practice Address - Phone:626-338-8407
Practice Address - Fax:626-338-3937
Is Sole Proprietor?:No
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA 14513363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical