| Choon Sil Koo, MD | |
|
999 San Bernardino Rd, Upland, CA 91786-4920 | |
| (909) 985-2811 | |
| (909) 920-3827 |
| Full Name | Choon Sil Koo |
|---|---|
| Gender | Male |
| Speciality | Pathology |
| Experience | 57 Years |
| Location | 999 San Bernardino Rd, Upland, California |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265427595 | NPI | - | NPPES |
| 00A315610 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207ZP0102X | Pathology - Anatomic Pathology & Clinical Pathology | A31561 (California) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| San Antonio Regional Hospital | Upland, CA | Hospital |
| Mountains Community Hospital | Lake arrowhead, CA | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Excel Pathology | 9436522646 | 3 |
| Entity Name | Excel Pathology |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1053022277 PECOS PAC ID: 9436522646 Enrollment ID: O20230308001192 |
| Mailing Address | Practice Location Address |
|---|---|
| Choon Sil Koo, MD Po Box 2311, Chatsworth, CA 91313-2311 Ph: (818) 718-9500 | Choon Sil Koo, MD 999 San Bernardino Rd, Upland, CA 91786-4920 Ph: (909) 985-2811 |
Miriam A Velazquez, DO Pathology Medicare: Accepting Medicare Assignments Practice Location: 999 San Bernardino Rd, Upland, CA 91786 Phone: 909-985-2811 | |
Dr. Dulce R Decastro, MD Pathology Medicare: Medicare Enrolled Practice Location: 999 San Bernardino Rd, Upland, CA 91786 Phone: 909-985-2811 Fax: 909-920-3827 | |
Howard P Charman, M.D. Pathology Medicare: Medicare Enrolled Practice Location: 999 San Bernardino Rd, Upland, CA 91786 Phone: 909-985-2811 Fax: 909-920-3827 |