Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant | 283972 |
NPI | 1386146827 |
---|---|
Provider Name | Kelly Koss |
First Address | Los Angeles, CA 90026-4959 |
Second Address | Los Angeles, CA 90027-6098 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2018 |
Last Update Date | 28/02/2018 |