Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | 042.0012769 | VT |
Y | 208800000X | Urologist | 79821 | MA |
NPI | 1083604219 |
---|---|
Provider Name | Dr. Dicken Shiu-Chung Ko |
First Address | Rumford, RI 02916-3603 |
Second Address | Providence, RI 02905-3246 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2005 |
Last Update Date | 28/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
079821 | TUFTS HEALTH PLAN (01) | MA |
3164845 | (05) | MA |
G43799 | (02) | |
J17470 | BCBS MA (01) | MA |