Healthcare Provider Details

I. General information

NPI: 1689744328
Provider Name (Legal Business Name): ANDREW PIN-WEI KO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 04/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 WARNER AVE STE 262
FOUNTAIN VALLEY CA
92708-7512
US

IV. Provider business mailing address

11100 WARNER AVE STE 262
FOUNTAIN VALLEY CA
92708-7512
US

V. Phone/Fax

Practice location:
  • Phone: 714-979-7788
  • Fax: 714-979-7799
Mailing address:
  • Phone: 714-979-7788
  • Fax: 714-979-7799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA76901
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: