MEDICARE: MARILYN KOO

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1700454709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARILYN KOO

Provider Business Mailing Address
First Line	:	1188 E WOODBURY RD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91104-1300
Country	:	US
Telephone Number	:	626-240-9927
Fax Number	:

Provider Business Practice Location Address
First Line	:	1360 E ANAHEIM ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-5514
Country	:	US
Telephone Number	:	562-218-9530
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2021
Last Update Date	:	06/15/2021

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Directions to “ MARILYN KOO ” Practice Location

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