Provider Demographics
NPI:1457913964
Name:SARFO, KOJO
Entity Type:Individual
Prefix:
First Name:KOJO
Middle Name:
Last Name:SARFO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12966 EUCLID ST STE 280
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-9202
Mailing Address - Country:US
Mailing Address - Phone:714-823-4770
Mailing Address - Fax:
Practice Address - Street 1:12966 EUCLID ST STE 280
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-9202
Practice Address - Country:US
Practice Address - Phone:714-823-4770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-03
Last Update Date:2023-10-11
Deactivation Date:2019-12-27
Deactivation Code:
Reactivation Date:2020-02-17
Provider Licenses
StateLicense IDTaxonomies
CANPF95019005363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner