Charles C Koo, MT PRACTITIONER

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

24005 Issued in CA

Practice address

430 Sherman Ave Ste 205
Palo Alto, CA 94306-1853

Phone

(650) 701-7246

NPI assigned

Oct 26, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Medical Technician

Practice roles

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.

• Pain Cure Center, Inc.

  • Massage Therapist
  • Palo Alto, CA
  • NPI 1407132095
  NPD (past) Authorized official

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

{
    "created_epoch": "1319587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319587200000",
    "number": "1194001875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 SHERMAN AVE STE 205",
            "city": "PALO ALTO",
            "state": "CA",
            "postal_code": "943061853",
            "telephone_number": "650-701-7246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 SHERMAN AVE STE 205",
            "city": "PALO ALTO",
            "state": "CA",
            "postal_code": "943061853",
            "telephone_number": "650-701-7246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOO",
        "first_name": "CHARLES",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "MT PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-10-26",
        "last_updated": "2011-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "CA",
            "license": "24005",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Li-Chung Kong, M.D.
• Kono DDS and Vanzina DDS, a Professional Corporation
• Peter Chang Kono, DDS
• Thomas Kono, DDS
• Katherine Chanel Konvinse, MD, PHD
• Euna Baughn Koo, MD
• Veronica Koo, AUD
• Heather Marie Koper, OTR/L
• Sara Sienna Kopit-Olson
• Danielle Kopplin, AUD

• Massage Therapist in Palo Alto, CA
• Providers in Palo Alto, CA by specialty
• Massage Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2011; 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.