| Dr. Kern S. Koo, General &family Medicine, P.c. | |
|
5133 Marathon Pkwy Little Neck NY 11362-1716 | |
| (718) 357-3458 | |
| (718) 357-3483 |
| Full Name | Dr. Kern S. Koo, General &family Medicine, P.c. |
|---|---|
| Speciality | Clinic/Center |
| Location | 5133 Marathon Pkwy, Little Neck, New York |
| Authorized Official Name and Position | Kern Scott Koo (PRESIDENT) |
| Authorized Official Contact | 7183573458 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr. Kern S. Koo, General &family Medicine, P.c. 5133 Marathon Pkwy Little Neck NY 11362-1716 Ph: (718) 357-3458 | Dr. Kern S. Koo, General &family Medicine, P.c. 5133 Marathon Pkwy Little Neck NY 11362-1716 Ph: (718) 357-3458 |
| NPI Number | 1457501082 |
|---|---|
| Provider Enumeration Date | 09/18/2008 |
| Last Update Date | 09/18/2008 |
| Medicare PECOS PAC ID | 3476694381 |
|---|---|
| Medicare Enrollment ID | O20100113000783 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457501082 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 221288 (New York) | Primary |
| Provider Name | Kern Scott Koo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679797088 PECOS PAC ID: 6800887001 Enrollment ID: I20040518000965 |
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