Healthcare Provider Details

I. General information

NPI: 1396315826
Provider Name (Legal Business Name): ANGELA KO, MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 N 15TH ST STE 290
PHOENIX AZ
85020-4336
US

IV. Provider business mailing address

8989 N GAINEY CENTER DR UNIT 145
SCOTTSDALE AZ
85258-2114
US

V. Phone/Fax

Practice location:
  • Phone: 734-945-5322
  • Fax: 602-277-8146
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: VANESSA KOZIOL
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 480-376-6456