Healthcare Provider Details

I. General information

NPI: 1598361537
Provider Name (Legal Business Name): HUN MIN KOO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2020
Last Update Date: 12/06/2020
Certification Date: 12/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

193 TUMON LN APT 105
TAMUNING GU
96913-4321
US

IV. Provider business mailing address

193 TUMON LN APT 105
TAMUNING GU
96913-4321
US

V. Phone/Fax

Practice location:
  • Phone: 671-489-8458
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number2019001864
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: