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General NPI Number Information
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NPI Number | 1588126288
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Entity Type | Individual
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Provider Name | CAROLINE J KO DPM
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Gender | Female
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Dates
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Enumeration Date | 04/02/2019
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 3600 BROADWAY STE 17
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City | OAKLAND
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State | CA
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Zip | 94611-5730
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Country | US
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Telephone | 510-752-1155
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Fax |
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Provider Business Mailing Address
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Address Line | 1333 POWELL ST UNIT A331
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City | EMERYVILLE
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State | CA
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Zip | 94608-2598
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Country | US
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Telephone | 574-850-1981
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 00000000
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License Number State | CA
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