Provider Demographics
NPI:1538168067
Name:GARN, KAREN SUE (PA)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:SUE
Last Name:GARN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39141 CIVIC CENTER DR STE 335
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-5878
Mailing Address - Country:US
Mailing Address - Phone:510-248-1414
Mailing Address - Fax:510-797-5850
Practice Address - Street 1:39141 CIVIC CENTER DR STE 335
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-5878
Practice Address - Country:US
Practice Address - Phone:510-248-1414
Practice Address - Fax:510-797-5850
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105108363A00000X
SCA447363AM0700X
SC447363AS0400X
CA54269363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY01PBOtherBCBS
SCQM0444Medicaid
SCQM0444Medicaid
SCS693356103Medicare ID - Type Unspecified