Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | GO81031 | CA |
NPI | 1205932050 |
---|---|
Provider Name | Ralph Koo |
First Address | Sacramento, CA 95816-5615 |
Second Address | Sacramento, CA 95816-5615 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2006 |
Last Update Date | 25/03/2010 |