Individual
KA CHA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4422 N PERSHING AVE STE D2, STOCKTON, CA 95207-6967
(209) 953-8843
Mailing address
4422 N PERSHING AVE STE D2, STOCKTON, CA 95207-6967
(209) 953-8843
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
09/03/2009
Last updated
09/03/2009
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