Healthcare Provider Details

I. General information

NPI: 1104400373
Provider Name (Legal Business Name): BRANDON HYUNMO KOO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE
SAN FRANCISCO CA
94143-2204
US

IV. Provider business mailing address

5133 MARATHON PKWY
LITTLE NECK NY
11362-1716
US

V. Phone/Fax

Practice location:
  • Phone: 415-514-5681
  • Fax:
Mailing address:
  • Phone: 347-884-1949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA206124
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: