Healthcare Provider Details

I. General information

NPI: 1013188317
Provider Name (Legal Business Name): KOA & KEONI MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 03/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 CENTRE ST STE 724
NEW YORK NY
10013-4552
US

IV. Provider business mailing address

139 CENTRE ST STE 724
NEW YORK NY
10013-4552
US

V. Phone/Fax

Practice location:
  • Phone: 212-334-2200
  • Fax:
Mailing address:
  • Phone: 212-334-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number230673
License Number StateNY

VIII. Authorized Official

Name: VIVIAN LI-HIRASHIKI
Title or Position: PRESIDENT
Credential: MD
Phone: 212-334-2200