Provider Demographics
NPI:1457794273
Name:KOUO, ASHLEY (LAC)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:KOUO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3361 PAR DR
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-8031
Mailing Address - Country:US
Mailing Address - Phone:858-692-9814
Mailing Address - Fax:
Practice Address - Street 1:1080 UNIVERSITY AVE
Practice Address - Street 2:SUITE H-201
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-3363
Practice Address - Country:US
Practice Address - Phone:858-692-9814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15176171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist