MEDICARE: DR. JORDAN KO PHD

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	103TC2200X	Clinical Child & Adolescent Psychologist	PSY32500	CA

General Provider Information

NPI Number	:	1710436001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORDAN KO PHD

Provider Business Mailing Address
First Line	:	12544 HIGH BLUFF DR STE 200
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-3050
Country	:	US
Telephone Number	:	858-215-2620
Fax Number	:

Provider Business Practice Location Address
First Line	:	12544 HIGH BLUFF DR STE 200
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-3050
Country	:	US
Telephone Number	:	858-215-2620
Fax Number	:

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

Provider Enumeration Date	:	09/27/2016
Last Update Date	:	12/19/2025

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