Koobamo,LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

019200695 Issued in CA

Legal business name

KOOBAMO,LLC

Doing business as

Good Shepherd Vista

Practice address

5472 Foothill Blvd
Oakland, CA 94601-5516

Phone

(408) 202-2236

NPI assigned

Mar 22, 2017

Organization subpart

No

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

Authorized official

Name

Hasmin Koo

Title

Managing Member

Phone

(408) 202-2236

Specialties & licenses 1

Addresses

Other names 1

• Good Shepherd Vista Doing business as

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

{
    "created_epoch": "1490140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490140800000",
    "number": "1104357102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5472 FOOTHILL BLVD",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946015516",
            "telephone_number": "408-202-2236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5472 FOOTHILL BLVD",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946015516",
            "telephone_number": "408-202-2236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOOBAMO,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-22",
        "last_updated": "2017-03-22",
        "status": "A",
        "authorized_official_last_name": "KOO",
        "authorized_official_first_name": "HASMIN",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "408-202-2236"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "CA",
            "license": "019200695",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Good Shepherd Vista",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Stanley Min Wint Lwin Kong, MD
• Wesley Kong
• Malissa Blake Konner, MSW
• Kimberle Sarah Konover, ASW
• John Karl Konstantin, M.D., M.P.H.
• Azmina Koorji, NURSE PRACTITIONER
• Sophia Koperweis
• Kristina Kopko, MA
• Suzanne Mary Kordesh, RD
• Neil Koris, MD

• Assisted Living Facility in Oakland, CA
• Providers in Oakland, CA by specialty
• Assisted Living Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 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.

Verify at the official NPI Registry.