Healthcare Provider Details

I. General information

NPI: 1295016475
Provider Name (Legal Business Name): BRYCE KO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2011
Last Update Date: 09/26/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11500 BROOKSHIRE AVE PIH HEALTH DOWNEY - DEPARTMENT OF EMERGENCY MEDICINE
DOWNEY CA
90241-4917
US

IV. Provider business mailing address

PO BOX 51351
IRVINE CA
92619-1351
US

V. Phone/Fax

Practice location:
  • Phone: 562-904-5000
  • Fax:
Mailing address:
  • Phone: 310-597-9146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA111956
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: