Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 15373 | CA |
NPI | 1033573480 |
---|---|
Provider Name | Ms. Sarah Ku |
First Address | Pomona, CA 91767-5445 |
Second Address | Rancho Cucamonga, CA 91730-5938 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2016 |
Last Update Date | 12/04/2016 |