Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | A114331 | CA |
Y | 2084N0402X | Child Neurologist | A114331 | CA |
NPI | 1396048351 |
---|---|
Provider Name | Ping-Ru Teresa Ko |
First Address | Santa Clara, CA 95051-5173 |
Second Address | Santa Clara, CA 95051-5173 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2010 |
Last Update Date | 15/12/2021 |