Basic Information
| Provider Information | |||||||||
| NPI: | 1679846174 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KETTUNEN | ||||||||
| FirstName: | CAROLYN | ||||||||
| MiddleName: | WENKAY-KWOK | ||||||||
| NamePrefix: | |||||||||
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| Credential: | DPT | ||||||||
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| OtherLastName: | KWOK | ||||||||
| OtherFirstName: | CAROLYN | ||||||||
| OtherMiddleName: | WENKAY | ||||||||
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| OtherCredential: | DPT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 402 TROPEA AISLE | ||||||||
| Address2: | |||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926060866 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 27700 MEDICAL CENTER RD | ||||||||
| Address2: | |||||||||
| City: | MISSION VIEJO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926916426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9493641400 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2012 | ||||||||
| LastUpdateDate: | 02/14/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 36274 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.