Healthcare Provider Details

I. General information

NPI: 1275826307
Provider Name (Legal Business Name): JOHN J KOO MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2011
Last Update Date: 05/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 ULUKAHIKI ST
KAILUA HI
96734-4454
US

IV. Provider business mailing address

PO BOX 25490
HONOLULU HI
96825-0490
US

V. Phone/Fax

Practice location:
  • Phone: 808-263-5500
  • Fax:
Mailing address:
  • Phone: 808-536-0300
  • Fax: 808-536-0320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD-14092
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD-14092
License Number StateHI

VIII. Authorized Official

Name: DR. JOHN J KOO
Title or Position: OWNER
Credential: M.D.
Phone: 808-352-1981