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General NPI Number Information
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NPI Number | 1457501082
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Entity Type | Organization
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Legal Business Name | DR. KERN S. KOO, GENERAL &FAMILY MEDICINE, P.C.
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Dates
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Enumeration Date | 09/18/2008
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Last Update Date | 09/18/2008
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Provider Practice Location Address
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Address Line | 5133 MARATHON PKWY
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City | LITTLE NECK
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State | NY
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Zip | 11362-1716
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Country | US
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Telephone | 718-357-3458
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Fax | 718-357-3483
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Provider Business Mailing Address
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Address Line | 5133 MARATHON PKWY
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City | LITTLE NECK
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State | NY
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Zip | 11362-1716
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Country | US
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Telephone | 718-357-3458
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Fax | 718-357-3483
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KERN SCOTT KOO
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Credential | D.O.
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Telephone | 718-357-3458
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 221288
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License Number State | NY
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