Active NPI
Kang H Ko, S.P
- Pharmacist
- Woodside, NY
National Provider Identifier
1508180779
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 30867
- Practice address
- 6319 Roosevelt Ave
Woodside, NY 11377-3641 - Phone
- (718) 429-2140
- Fax
- (718) 565-5987
- NPI assigned
- Mar 17, 2010
- Sex
- Male
- Sole proprietor
- Yes
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 | 30867 | NY | Primary |
Addresses
Primary practice location
6319 Roosevelt Ave
Woodside, NY 11377-3641
Mailing address
62-10 Woodside Ave
Suite No. 312
Woodside, NY 11377
Phone (718) 565-8354
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00542847 | Medicaid | NY |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30867 | NY | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1268784000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1268784000000",
"number": "1508180779",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "62-10 WOODSIDE AVE",
"address_2": "SUITE NO. 312",
"city": "WOODSIDE",
"state": "NY",
"postal_code": "11377",
"telephone_number": "718-565-8354",
"fax_number": "718-565-5987"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6319 ROOSEVELT AVE",
"city": "WOODSIDE",
"state": "NY",
"postal_code": "113773641",
"telephone_number": "718-429-2140",
"fax_number": "718-565-5987"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KO",
"first_name": "KANG",
"middle_name": "H",
"name_prefix": "Mr.",
"credential": "S.P",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-03-17",
"last_updated": "2010-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "30867",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00542847",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Woodside, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.