Healthcare Provider Details

I. General information

NPI: 1720109150
Provider Name (Legal Business Name): JAMES YOUNG JOO KO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 12/15/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 LAWRENCE EXPY DEPARTMENT 200
SANTA CLARA CA
95051-5173
US

IV. Provider business mailing address

700 LAWRENCE EXPY DEPARTMENT 200
SANTA CLARA CA
95051-5173
US

V. Phone/Fax

Practice location:
  • Phone: 408-851-6020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberA111595
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA111595
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: