Provider Demographics
NPI:1336699933
Name:KO, SARAH CHO (PMHNP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:CHO
Last Name:KO
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:HYANG
Other - Middle Name:RIM
Other - Last Name:KO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP
Mailing Address - Street 1:3030 W OLYMPIC BLVD STE 217
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-6507
Mailing Address - Country:US
Mailing Address - Phone:213-550-2159
Mailing Address - Fax:
Practice Address - Street 1:3030 W OLYMPIC BLVD STE 217
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-6507
Practice Address - Country:US
Practice Address - Phone:213-550-2159
Practice Address - Fax:888-820-9903
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-06
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004554363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health