Jesse Ko, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

213571-1 Issued in NY

Practice address

20945 45TH Rd FL 1
Bayside, NY 11361-3233

Phone

(718) 423-7200

Fax

(718) 224-8727

NPI assigned

Apr 24, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H9678

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

• Jesse Ko, MD, PLLC

  • Pediatrics Physician
  • Bayside, NY
  • NPI 1518145366
  NPD Authorized official

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

{
    "created_epoch": "1145836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690243200000",
    "number": "1770549289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20945 45TH RD FL 1",
            "city": "BAYSIDE",
            "state": "NY",
            "postal_code": "113613233",
            "telephone_number": "718-423-7200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20945 45TH RD FL 1",
            "city": "BAYSIDE",
            "state": "NY",
            "postal_code": "113613233",
            "telephone_number": "718-423-7200",
            "fax_number": "718-224-8727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KO",
        "first_name": "JESSE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-24",
        "last_updated": "2023-07-25",
        "certification_date": "2023-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NJ",
            "license": "MA 068417",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "213571-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Knickerbocker Dialysis Inc
• Ira Knobler
• Emily Faith Ko
• Esther Ko
• Injung Ko, NP
• Stanley G Ko
• Richard Wallace Koffler, CASAC
• Omid Kohani, MD
• Michael Kokolis, DDS
• Adam J Kolesar, MSP.,CCC-SLP, BRS-S

• Pediatrics Physician in Bayside, NY
• Providers in Bayside, NY by specialty
• Pediatrics Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2023; 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.