Active NPI
Dominic Jung Soo Koo, PT
- Physical Therapist
- Las Vegas, NV
National Provider Identifier
1013424068
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 3661
- Practice address
- 2800 E Desert Inn Rd Ste 200
Las Vegas, NV 89121-3632 - Phone
- (702) 294-7499
- NPI assigned
- Dec 29, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 3661 | NV | Primary |
Addresses
Primary practice location
2800 E Desert Inn Rd Ste 200
Las Vegas, NV 89121-3632
Mailing address
151 Kanunu St
Apt 1404
Honolulu, HI 96814
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3661 | NV | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1514505600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1514505600000",
"number": "1013424068",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "151 KANUNU ST",
"address_2": "APT 1404",
"city": "HONOLULU",
"state": "HI",
"postal_code": "96814"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2800 E DESERT INN RD STE 200",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891213632",
"telephone_number": "702-294-7499"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOO",
"first_name": "DOMINIC",
"middle_name": "JUNG SOO",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-12-29",
"last_updated": "2017-12-29",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NV",
"license": "3661",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.