Healthcare Provider Details

I. General information

NPI: 1710061742
Provider Name (Legal Business Name): RICHARD JIN-HYUK KO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5150 E DUBLIN GRANVILLE RD STE 340
COLUMBUS OH
43081-7128
US

IV. Provider business mailing address

PO BOX 7527
DUBLIN OH
43017-0727
US

V. Phone/Fax

Practice location:
  • Phone: 614-566-4350
  • Fax: 614-566-4358
Mailing address:
  • Phone:
  • Fax: 614-544-6370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number34.009862
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number34.009862
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: