Healthcare Provider Details

I. General information

NPI: 1558542340
Provider Name (Legal Business Name): RICKY KOT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 11/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 37TH AVE
SAN MATEO CA
94403-4324
US

IV. Provider business mailing address

225 37TH AVE
SAN MATEO CA
94403-4324
US

V. Phone/Fax

Practice location:
  • Phone: 650-573-3900
  • Fax: 650-573-2193
Mailing address:
  • Phone: 650-573-3900
  • Fax: 650-573-2193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: