Healthcare Provider Details

I. General information

NPI: 1104694850
Provider Name (Legal Business Name): JOSEPH K KOO MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2023
Last Update Date: 12/23/2023
Certification Date: 12/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 N KUAKINI ST
HONOLULU HI
96817-2364
US

IV. Provider business mailing address

PO BOX 57
HONOLULU HI
96810-0057
US

V. Phone/Fax

Practice location:
  • Phone: 808-523-6461
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH K KOO
Title or Position: OWNER
Credential: MD
Phone: 808-722-1280