MEDICARE: DR. SAMUEL S. KOO MD, MPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	036-114852	IL
2	207X00000X	Orthopaedic Surgery Physician	MD600772440	WA

General Provider Information

NPI Number	:	1467626374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL S. KOO MD, MPH

Provider Business Mailing Address
First Line	:	805 MADISON ST
Second Line	:	SUITE 901
City	:	SEATTLE
State	:	WA
Zip	:	98104-1172
Country	:	US
Telephone Number	:	206-264-8100
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 BOREN AVE
Second Line	:	#800
City	:	SEATTLE
State	:	WA
Zip	:	98104-3534
Country	:	US
Telephone Number	:	206-323-1900
Fax Number	:	206-323-6868

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2008
Last Update Date	:	12/31/2012

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