Provider Demographics
NPI:1063802437
Name:KAO, TRUDY (FNP)
Entity type:Individual
Prefix:
First Name:TRUDY
Middle Name:
Last Name:KAO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 S. FREMONT AVE UNIT 22
Mailing Address - Street 2:BUILDING A6, 4TH FL, RM 6436
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803
Mailing Address - Country:US
Mailing Address - Phone:213-740-9355
Mailing Address - Fax:213-740-4961
Practice Address - Street 1:1031 W 34TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-3505
Practice Address - Country:US
Practice Address - Phone:213-740-9355
Practice Address - Fax:213-740-4961
Is Sole Proprietor?:No
Enumeration Date:2015-01-23
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016513363LF0000X
CA95001819363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily