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NPI Code Detail

MEDICARE: GRACE KOO M.D.

MEDICARE: GRACE 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
1207R00000XInternal Medicine Physician036148471IL
2207RA0201XAllergy & Immunology (Internal Medicine) Physician036148471IL
3208M00000XHospitalist Physician036148471IL
4207K00000XAllergy & Immunology Physician65411TN
5207R00000XInternal Medicine Physician65411TN

General Provider Information

NPI Number : 1255788659
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRACE KOO M.D.
Provider Business Mailing Address
First Line : 3841 GREEN HILLS VILLAGE DR
Second Line :
City : NASHVILLE
State : TN
Zip : 37215-2691
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3601 THE VANDERBILT CLINIC
Second Line :
City : NASHVILLE
State : TN
Zip : 37232-6013
Country : US
Telephone Number : 615-936-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2016
Last Update Date : 01/10/2024

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