Provider Demographics
NPI:1962917252
Name:KU, CONNIE YUNG-JANE (FNP-C)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:YUNG-JANE
Last Name:KU
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N CHAPEL AVE APT 118
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-6004
Mailing Address - Country:US
Mailing Address - Phone:626-215-2736
Mailing Address - Fax:
Practice Address - Street 1:600 N GARFIELD AVE STE 111
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1167
Practice Address - Country:US
Practice Address - Phone:626-280-3651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-08
Last Update Date:2019-03-20
Deactivation Date:2018-01-17
Deactivation Code:
Reactivation Date:2019-03-20
Provider Licenses
StateLicense IDTaxonomies
CA95007736363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily