Active NPI
Kyung Mo Koo, PHARMD
- Pharmacist
- San Diego, CA
National Provider Identifier
1144856014
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 78605
- Practice address
- 12310 World Trade Dr
San Diego, CA 92128-3793 - Phone
- (858) 576-6969
- NPI assigned
- Mar 22, 2020
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 78605 | CA | Primary |
Addresses
Primary practice location
12310 World Trade Dr
San Diego, CA 92128-3793
Mailing address
8583 Aero Dr Apt 2112
San Diego, CA 92123-1625
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)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 78605 | CA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Coram Alternate Site Services Inc | Past | Accepting new patients | |
| Coram Alternate Site Services Inc | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Home Infusion Therapy Pharmacy
- San Diego, CA
- NPI 1790734036
-
- Home Infusion Therapy Pharmacy
- Phoenix, AZ
- NPI 1164471405
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1584835200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1584835200000",
"number": "1144856014",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8583 AERO DR APT 2112",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921231625"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12310 WORLD TRADE DR",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921283793",
"telephone_number": "858-576-6969"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOO",
"first_name": "KYUNG MO",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-03-22",
"last_updated": "2020-03-22",
"certification_date": "2020-03-22",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "78605",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.