Provider Demographics
NPI:1154398055
Name:KO, HAK J (MD)
Entity type:Individual
Prefix:
First Name:HAK
Middle Name:J
Last Name:KO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5687 MAIN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5517
Mailing Address - Country:US
Mailing Address - Phone:716-204-3541
Mailing Address - Fax:716-204-3542
Practice Address - Street 1:5687 MAIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5517
Practice Address - Country:US
Practice Address - Phone:716-204-3541
Practice Address - Fax:716-204-3542
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2010-07-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1375672084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00020222401OtherUNIVERA
NY1509258OtherINDEPENDENT HEALTH
NY00508010006OtherBLUE CROSS BLUE SHIELD
NY00685534Medicaid
NY1509258OtherINDEPENDENT HEALTH
NY080102Medicare ID - Type Unspecified