Provider Demographics
NPI:1376177691
Name:KOH, STEPHANIE SUN (FNP-C)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:SUN
Last Name:KOH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3103 DAVID AVE
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-3944
Mailing Address - Country:US
Mailing Address - Phone:732-770-6484
Mailing Address - Fax:
Practice Address - Street 1:777 N RAINBOW BLVD STE 350
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-1188
Practice Address - Country:US
Practice Address - Phone:833-208-0588
Practice Address - Fax:702-921-9712
Is Sole Proprietor?:No
Enumeration Date:2020-02-25
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV826301363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily