Organization Active NPI

Ko Surgical Associates P.C

  • Surgery Physician
  • Lombard, IL
National Provider Identifier
1225137359
Registry record updated Jan 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
KO SURGICAL ASSOCIATES P.C
Practice address
130 S Main St Ste 306
Lombard, IL 60148-2670
Phone
(630) 620-6040
Fax
(630) 620-6143
NPI assigned
Sep 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2016

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

Authorized official

Name
Sung-Tao Ko, M.D.
Title
President/Owner
Phone
(630) 833-0386

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

130 S Main St Ste 306
Lombard, IL 60148-2670

Mailing address

130 S Main St Ste 306
Lombard, IL 60148-2670
Phone (630) 620-6040

Other identifiers 2

IdentifierTypeStateIssuer
036-045253MedicaidIL
0002215295OtherILBLUE CROSS

National Provider Directory

National Provider Directory

Locations

386 N York St
Ste 201
Elmhurst, IL 60126
Phone (630) 620-6040

130 S Main St
Ste 306
Lombard, IL 60148
Phone (630) 620-6040

NPI Registry JSON

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452038400000",
    "number": "1225137359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 S MAIN ST STE 306",
            "city": "LOMBARD",
            "state": "IL",
            "postal_code": "601482670",
            "telephone_number": "630-620-6040",
            "fax_number": "630-620-6143"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 S MAIN ST STE 306",
            "city": "LOMBARD",
            "state": "IL",
            "postal_code": "601482670",
            "telephone_number": "630-620-6040",
            "fax_number": "630-620-6143"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KO SURGICAL ASSOCIATES P.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-22",
        "last_updated": "2016-01-06",
        "status": "A",
        "authorized_official_last_name": "KO",
        "authorized_official_first_name": "SUNG-TAO",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "630-833-0386",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036-045253",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "0002215295",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lombard, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2016; 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.