Provider Demographics
NPI:1679742779
Name:KAO, CHUN-JU
Entity type:Individual
Prefix:
First Name:CHUN-JU
Middle Name:
Last Name:KAO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 PAYTON
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-3455
Mailing Address - Country:US
Mailing Address - Phone:714-931-7222
Mailing Address - Fax:
Practice Address - Street 1:217 W CERRITOS AVE BLDG 8
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-6549
Practice Address - Country:US
Practice Address - Phone:714-254-8473
Practice Address - Fax:714-254-8480
Is Sole Proprietor?:No
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF53249106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist