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General NPI Number Information
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NPI Number | 1407851793
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Entity Type | Individual
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Provider Name | KIM ONG GOCOCO MD
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Gender | Male
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Dates
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Enumeration Date | 06/15/2005
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Last Update Date | 12/20/2022
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Provider Practice Location Address
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Address Line | 65 INTERNATIONAL DR
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City | GREENVILLE
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State | SC
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Zip | 29615-4816
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Country | US
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Telephone | 864-987-7000
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Fax | 864-672-7852
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Provider Business Mailing Address
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Address Line | 300 E MCBEE AVE FL 4
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City | GREENVILLE
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State | SC
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Zip | 29601-2842
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Country | US
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Telephone | 864-522-8603
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 15816
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License Number State | SC
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