Provider Demographics
NPI:1598015810
Name:KO, CATHERINE (RD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:KO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 W DUARTE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7617
Mailing Address - Country:US
Mailing Address - Phone:626-446-1740
Mailing Address - Fax:
Practice Address - Street 1:650 W DUARTE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7617
Practice Address - Country:US
Practice Address - Phone:626-446-1740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1055191133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered