Healthcare Provider Details

I. General information

NPI: 1457350985
Provider Name (Legal Business Name): JOSEPH K. KOO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 12/23/2023
Certification Date: 12/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 N. KUAKINI STREET, SUITE 715 KUAKINI MEDICAL PLAZA
HONOLULU HI
96817
US

IV. Provider business mailing address

PO BOX 57
HONOLULU HI
96810-0057
US

V. Phone/Fax

Practice location:
  • Phone: 808-523-6461
  • Fax: 808-550-0466
Mailing address:
  • Phone: 808-836-3303
  • Fax: 808-836-3303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMD-6718
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: