Healthcare Provider Details

I. General information

NPI: 1144754557
Provider Name (Legal Business Name): STEPHANIE KO DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2017
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 S MAIN ST
WALNUT CREEK CA
94596-5318
US

IV. Provider business mailing address

1425 S MAIN ST
WALNUT CREEK CA
94596-5318
US

V. Phone/Fax

Practice location:
  • Phone: 925-295-4000
  • Fax:
Mailing address:
  • Phone: 925-295-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5775
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: