Active NPI
Kelly Hwa Koo, PH.D.
- Clinical Psychologist
- San Bruno, CA
National Provider Identifier
1740521970
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY27845
- Practice address
- 1001 Sneath LN
Suite 300
San Bruno, CA 94066-2308 - Phone
- (650) 615-6075
- NPI assigned
- Mar 13, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | CA | ||
| Clinical Psychologist | 103TC0700X | PSY27845 | CA | Primary |
Addresses
Primary practice location
1001 Sneath LN
Suite 300
San Bruno, CA 94066-2308
Mailing address
1001 Sneath LN
Suite 300
San Bruno, CA 94066-2308
Phone (650) 615-6075
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Jan 24, 2022 through Jan 24, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY27845 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1363132800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1451952000000",
"number": "1740521970",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1001 SNEATH LN",
"address_2": "SUITE 300",
"city": "SAN BRUNO",
"state": "CA",
"postal_code": "940662308",
"telephone_number": "650-615-6075"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 SNEATH LN",
"address_2": "SUITE 300",
"city": "SAN BRUNO",
"state": "CA",
"postal_code": "940662308",
"telephone_number": "650-615-6075"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOO",
"first_name": "KELLY",
"middle_name": "HWA",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-03-13",
"last_updated": "2016-01-05",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "CA",
"license": null,
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY27845",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Bruno, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2016; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.