Healthcare Provider Details

I. General information

NPI: 1093961435
Provider Name (Legal Business Name): MICHAEL S KO DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 N TUSTIN AVE STE 355
SANTA ANA CA
92705-8684
US

IV. Provider business mailing address

1401 N TUSTIN AVE STE 355
SANTA ANA CA
92705-8684
US

V. Phone/Fax

Practice location:
  • Phone: 714-867-1682
  • Fax: 714-364-1064
Mailing address:
  • Phone: 714-867-1682
  • Fax: 714-364-1064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number33846
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: