Healthcare Provider Details

I. General information

NPI: 1255002655
Provider Name (Legal Business Name): KAREN E. KOE M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2021
Last Update Date: 09/24/2021
Certification Date: 09/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10861 CHERRY ST STE 103
LOS ALAMITOS CA
90720-5403
US

IV. Provider business mailing address

10861 CHERRY ST STE 103
LOS ALAMITOS CA
90720-5403
US

V. Phone/Fax

Practice location:
  • Phone: 562-595-1961
  • Fax: 562-595-5351
Mailing address:
  • Phone: 562-595-1961
  • Fax: 562-595-5351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RUBY ROSALES
Title or Position: MANAGER
Credential:
Phone: 562-826-6534