Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 036148471 | IL |
Y | 111NI0900X | Internist | 036148471 | IL |
N | 207RA0201X | Internist - Allergy & Immunology | 036148471 | IL |
NPI | 1255788659 |
---|---|
Provider Name | Grace Koo |
First Address | Nashville, TN 37203-6013 |
Second Address | Nashville, TN 37203-6013 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2016 |
Last Update Date | 17/06/2020 |