Provider Demographics
NPI:1902296429
Name:JU, JOANN
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:JU
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 1:7431 FRANKLIN ST
Mailing Address - Street 2:APT. #3
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-1878
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7431 FRANKLIN ST
Practice Address - Street 2:APT. #3
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-1878
Practice Address - Country:US
Practice Address - Phone:714-315-1990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-04
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14948225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist