Provider Demographics
NPI:1306938642
Name:BOBBY KO MD INC
Entity type:Organization
Organization Name:BOBBY KO MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES BOBBY KO MD & NC & 100 OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:CHU
Authorized Official - Last Name:KO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-944-0307
Mailing Address - Street 1:15217 LEFFINGWELL RD
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90604
Mailing Address - Country:US
Mailing Address - Phone:562-944-0307
Mailing Address - Fax:562-944-0309
Practice Address - Street 1:15217 LEFFINGWELL RD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90604
Practice Address - Country:US
Practice Address - Phone:562-944-0307
Practice Address - Fax:562-944-0309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC037592207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A36682Medicare UPIN
W7231Medicare ID - Type Unspecified