Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 6953 | AK |
Y | 208600000X | Surgeon | 6953 | AK |
NPI | 1003995713 |
---|---|
Provider Name | Tak Ming Ko |
First Address | Palmer, AK 99645-7408 |
Second Address | Palmer, AK 99645-7408 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2006 |
Last Update Date | 26/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1019943 | (05) | AK |
BK6625365 | DEA (01) | AK |