Individual
AVIS KO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
3609 10TH AVE, LOS ANGELES, CA 90018-4114
(323) 298-3680
Mailing address
119 E COLORADO AVE, GLENDORA, CA 91740-4411
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
3922
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
CA
Other
Enumeration date
04/18/2024
Last updated
07/16/2026
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