Provider Demographics
NPI:1588135081
Name:MENSAH, KARIN
Entity type:Individual
Prefix:
First Name:KARIN
Middle Name:
Last Name:MENSAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KARIN
Other - Middle Name:ELINAM
Other - Last Name:KETEKU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:611 E IMPERIAL HWY STE 107
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90059-2359
Mailing Address - Country:US
Mailing Address - Phone:323-732-0100
Mailing Address - Fax:
Practice Address - Street 1:611 E IMPERIAL HWY STE 107
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90059-2359
Practice Address - Country:US
Practice Address - Phone:818-361-4111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-09
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95010507363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily