Provider Demographics
NPI:1376850883
Name:KON, JOCELYN POGUE (ACNP)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:POGUE
Last Name:KON
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:JOCELYN
Other - Middle Name:
Other - Last Name:POGUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACNP
Mailing Address - Street 1:5767 W CENTURY BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:310-825-8138
Mailing Address - Fax:
Practice Address - Street 1:UCLA DEPARTMENT OF LIVER TRANSPLANT SURGERY
Practice Address - Street 2:757 WESTWOOD PLAZA 8501
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-0001
Practice Address - Country:US
Practice Address - Phone:310-825-8138
Practice Address - Fax:310-794-3344
Is Sole Proprietor?:No
Enumeration Date:2010-09-03
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA688796163W00000X
CA20171363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN688796OtherMEDI CAL
CA1902862170OtherMEDI CAL
CARN688796OtherMEDI CAL