Provider Demographics
NPI:1972568236
Name:KO, STEPHEN (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:KO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:321 N KUAKINI ST
Mailing Address - Street 2:SUITE 405
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2364
Mailing Address - Country:US
Mailing Address - Phone:808-522-0190
Mailing Address - Fax:808-523-9068
Practice Address - Street 1:347 N KUAKINI ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2306
Practice Address - Country:US
Practice Address - Phone:808-522-0190
Practice Address - Fax:808-523-9068
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2017-02-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
HIMD111182085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI494930-02OtherST DEPT OF PUB SAFETY
HI990157698-96701-B010OtherTRICARE
HI990157698009OtherHI ELEC
HIB224614OtherHMSA
HI00B0224614OtherQUEST HMSA
HI494930-01OtherST DEPT OF PUB SAFETY
HI103802483OtherUS MARSHALL SVC-FED DET C
HI204243800OtherUS LABOR DEPT
HI00A0224616OtherQUEST HMSA
HI108-2145098OtherAETNA
HI0049493001Medicaid
HI300113204OtherPALMETTO GBA
HIA224616OtherHMSA
HIMD11118OtherQUEENS HEALTHCARE
HI0049493002Medicaid
HI990157698-96817-E010OtherTRICARE
HI494930-01OtherST DEPT OF PUB SAFETY
HI0049493002Medicaid