NPIMap

Individual provider Active NPI

Wei Loong Glenn Koh, MD

  • Surgery Physician
  • Modesto, CA
National Provider Identifier
1013101633
Registry record updated Feb 13, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
A118722 Issued in CA
Practice address
4601 Dale Rd
Suite 4A5
Modesto, CA 95356-9718
Phone
(925) 200-1811
NPI assigned
Aug 28, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X A118722 CA Primary

Addresses

Primary practice location

4601 Dale Rd
Suite 4A5
Modesto, CA 95356-9718

Mailing address

4601 Dale Rd
#4A5
Modesto, CA 95356-9718
Phone (925) 200-1811

Other names 1

  • Glenn Koh Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120831000636 CA Practitioner - General Surgery 8921152612 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kern County Hospital AuthorityGroup PAC ID 4688964521, 264 clinicians

Practice addresses (Care Compare)

1700 Mount Vernon Ave
Bakersfield, CA 93306-4018
Phone (661) 326-2000

202 W Willow Ave
Suite 305
Visalia, CA 93291-6238
Phone (559) 774-0124

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
87.97 of 100Reported as group
Quality
47.69
Promoting interoperability
100
Improvement activities
40
Cost
82.27

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A118722CAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
County of San Joaquin CurrentSince Jun 10, 2015 Accepting new patients
Kern County Hospital Authority CurrentSince Apr 17, 2019 Accepting new patients
Acute Care Surgery Medical Group, Inc. Surgery CurrentSince Jun 1, 2015 Accepting new patients
Surgical Affiliates of California Surgery CurrentSince Feb 1, 2015 Accepting new patients
San Joaquin Faculty Medical Group CurrentSince Jun 10, 2015 Accepting new patients
Kern County Hospital Authority CurrentSince Apr 17, 2019 Accepting new patients
County of San Joaquin CurrentSince Jun 10, 2015 Accepting new patients
Acute Care Surgery Medical Group, Inc. Surgery PastSince Jul 2, 2023 Accepting new patients

Locations

1700 Mount Vernon Ave
Bakersfield, CA 93306
Phone (616) 326-2000

500 W Hospital Rd
French Camp, CA 95231
Phone (209) 468-6000

5176 Hill Rd E
Lakeport, CA 95453
Phone (707) 262-5000

807 Illinois Ave
Los Banos, CA 93635
Phone (209) 710-8542

520 W I St
Los Banos, CA 93635
Phone (209) 724-0316

350 Terracina Blvd
Redlands, CA 92373
Phone (909) 335-5500

375 Terracina Blvd
#B
Redlands, CA 92373
Phone (909) 279-0070

4001 J St
Sacramento, CA 95819
Phone (916) 453-4037

150 N Jackson Ave
Ste 100
San Jose, CA 95116
Phone (408) 769-5340

225 N Jackson Ave
San Jose, CA 95116
Phone (408) 347-4051

1800 Spring Ridge Dr
Susanville, CA 96130
Phone (530) 252-2225

202 W Willow Ave
Ste 305
Visalia, CA 93291
Phone (559) 622-8687

400 W Mineral King Ave
Visalia, CA 93291
Phone (559) 624-2001

Interoperability endpoints

  • Direct secure messaging: wkoh298943@hisp.ehr.sutterhealth.org

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1188259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1392249600000",
    "number": "1013101633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4601 DALE RD",
            "address_2": "#4A5",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953569718",
            "telephone_number": "925-200-1811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4601 DALE RD",
            "address_2": "SUITE 4A5",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953569718",
            "telephone_number": "925-200-1811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOH",
        "first_name": "WEI LOONG GLENN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-28",
        "last_updated": "2014-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "A118722",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GLENN",
            "last_name": "KOH",
            "credential": "MD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Modesto, CA

Sources for this page

Verify at the official NPI Registry.