Active NPI
Bernard Koo, DDS
- Dentist
- Los Angeles, CA
National Provider Identifier
1699803049
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 37437
- Practice address
- 420 Ord St
Suite 102-a
Los Angeles, CA 90012-2834 - Phone
- (213) 617-0136
- NPI assigned
- Feb 28, 2007
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 37437 | CA | Primary |
Addresses
Primary practice location
420 Ord St
Suite 102-a
Los Angeles, CA 90012-2834
Mailing address
1490 Atoll
West Covina, CA 91790-3383
Phone (626) 960-9660
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160629003157 | CA | Order and Referring Only - Dentist | 8820380447 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 37437 | CA | MD | Dentist |
Interoperability endpoints
- bernard.koo.p1@direct.cscla.nextgenshare.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172620800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1699803049",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1490 ATOLL",
"city": "WEST COVINA",
"state": "CA",
"postal_code": "917903383",
"telephone_number": "626-960-9660"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "420 ORD ST",
"address_2": "SUITE 102-A",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900122834",
"telephone_number": "213-617-0136"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOO",
"first_name": "BERNARD",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "37437",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.