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NPI Code Detail

MEDICARE: DR. BON CHUL KOO M.D.

MEDICARE: DR. BON CHUL KOO M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician35043277OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1205829280
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BON CHUL KOO M.D.
Provider Business Mailing Address
First Line : 4853 GALAXY PKWY
Second Line : SUITE I
City : CLEVELAND
State : OH
Zip : 44128-5973
Country : US
Telephone Number : 216-831-9786
Fax Number : 216-831-2425
Provider Business Practice Location Address
First Line : 4853 GALAXY PKWY
Second Line : SUITE I
City : CLEVELAND
State : OH
Zip : 44128-5973
Country : US
Telephone Number : 216-831-9786
Fax Number : 216-831-2425
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2005
Last Update Date : 06/27/2014

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Directions to “ DR. BON CHUL KOO M.D.” Practice Location

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