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1043182942 NPI number — KYUNG JIN KO RPH

NPI Number: 1043182942
Health Care Provider/Practitioner: KYUNG JIN KO RPH

Information about “1043182942” NPI (KYUNG JIN KO RPH) exists in 1043182942 in HTML format HTML  |  1043182942 in plain Text format TXT  |  1043182942 in PDF (Portable Document Format) PDF  |  1043182942 in an XML format XML  formats.

NPI Number : 1043182942 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1043182942",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KO",
    "FirstName": "KYUNG JIN",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "RPH",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "KO",
    "OtherFirstName": "JEANNIE",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "RPH",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "6695 SW NYBERG LN APT 203",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "TUALATIN",
    "MailingAddressStateName": "OR",
    "MailingAddressPostalCode": "97062-7811",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "503-927-5208",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "12240 SW SCHOLLS FERRY RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "TIGARD",
    "PracticeLocationAddressStateName": "OR",
    "PracticeLocationAddressPostalCode": "97223-3354",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "503-639-3446",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/19/2025",
    "LastUpdateDate": "09/22/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "183500000X",
        "TaxonomyName": "Pharmacist",
        "LicenseNumber": "RPH-0020439",
        "LicenseNumberStateCode": "OR",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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