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1790838092 NPI number — GREGORY K.W. KO O.D.

NPI Number: 1790838092
Health Care Provider/Practitioner: GREGORY K.W. KO O.D.

Information about “1790838092” NPI (GREGORY K.W. KO O.D.) exists in 1790838092 in HTML format HTML  |  1790838092 in plain Text format TXT  |  1790838092 in PDF (Portable Document Format) PDF  |  1790838092 in an XML format XML  formats.

NPI Number : 1790838092 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1790838092",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KO",
    "FirstName": "GREGORY",
    "MiddleName": "K.W.",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "O.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4180 LARK CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FREMONT",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "94555-1116",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "510-477-0437",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5580 SPRINGDALE AVE",
    "SecondLinePracticeLocationAddress": "STE E",
    "PracticeLocationAddressCityName": "PLEASANTON",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "94588-3707",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "925-463-3100",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/19/2007",
    "LastUpdateDate": "07/08/2007",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "152W00000X",
        "TaxonomyName": "Optometrist",
        "LicenseNumber": "5976T",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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