Kathryn Han Koo, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

30260 Issued in CA

Practice address

12362 Beach Blvd Ste 10
Stanton, CA 90680-3944

Phone

(714) 248-9500

NPI assigned

Aug 21, 2018

Last updated

Aug 10, 2023By the provider in NPPES

Sex

Female

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

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Livingstone Community Development CorporationGroup PAC ID 9931323706, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Livingstone Community Development Corporation

  dba Livingstone Community Health Clinic

  • Federally Qualified Health Center (FQHC)
  • Stanton, CA
  • NPI 1952662686
  Medicare reassignment Care Compare group NPD
• Livingstone Community Development Corporation

  dba Livingstone Community Health Clinic

  • Federally Qualified Health Center (FQHC)
  • Fullerton, CA
  • NPI 1881210318
  NPD

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

{
    "created_epoch": "1534809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691625600000",
    "number": "1356821060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12362 BEACH BLVD STE 10",
            "city": "STANTON",
            "state": "CA",
            "postal_code": "906803944",
            "telephone_number": "714-248-9500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12362 BEACH BLVD STE 10",
            "city": "STANTON",
            "state": "CA",
            "postal_code": "906803944",
            "telephone_number": "714-248-9500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOO",
        "first_name": "KATHRYN",
        "middle_name": "HAN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-21",
        "last_updated": "2023-08-10",
        "certification_date": "2023-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "30260",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Yvett Yoon Kim, FNP
• Kimberly Bao Nguyen, a Dental Corp
• Alondra R R King
• Devon Kishketon
• KLMH Enterprises LLC
• Setareh Kouchmeshki
• Breanon Kratzer, RADTI
• Marion Louise Krizo
• Katie Kubo
• Kurtis S Kanemaru, DMD, Inc

• Psychologist in Stanton, CA
• Providers in Stanton, CA by specialty
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.