Healthcare Provider Details

I. General information

NPI: 1700712734
Provider Name (Legal Business Name): HYUNWOO KOO CNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7618 NE 154TH AVE
VANCOUVER WA
98682-5110
US

IV. Provider business mailing address

7618 NE 154TH AVE
VANCOUVER WA
98682-5110
US

V. Phone/Fax

Practice location:
  • Phone: 952-818-7893
  • Fax:
Mailing address:
  • Phone: 952-818-7893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number10888184
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: