Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | A91662 | CA |
NPI | 1003841693 |
---|---|
Provider Name | Dr. Richard H. Ko |
First Address | Los Angeles, CA 90028-7901 |
Second Address | Los Angeles, CA 90027-6016 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 31/08/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A916620 | (05) | CA |