NPIMap

Individual provider Active NPI

Justin Meng Ko, MD

  • Dermatology Physician
  • Stanford, CA
National Provider Identifier
1790912251
Registry record updated Apr 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
A120641 Issued in CA
Practice address
300 Pasteur Dr
Stanford, CA 94305-2200
Phone
(650) 723-4000
NPI assigned
Jun 11, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X L-239279 MA
Dermatology Physician 207N00000X A120641 CA Primary

Addresses

Primary practice location

300 Pasteur Dr
Stanford, CA 94305-2200

Mailing address

440 Broadway St FL B4
Redwood City, CA 94063-3123
Phone (650) 723-6316

Other practice location 1

440 Broadway St Fl B4
Redwood City, CA 94063-3123
Phone (650) 723-6316

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121026000141 CA Practitioner - Dermatology 6709043144 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Tufts University School of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Stanford Health CareGroup PAC ID 6709797491, 3,152 clinicians

Practice addresses (Care Compare)

300 Pasteur Dr
Stanford, CA 94305-2200
Phone (650) 723-4000

420 Broadway St
Redwood City, CA 94063-3132
Phone (650) 723-4000

450 Broadway St
Redwood City, CA 94063-3132
Phone (650) 723-4000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.53 of 100Reported as group
Quality
87.08
Promoting interoperability
100
Improvement activities
40
Cost
69.51

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions95
Removal or shaving of skin growth1-10
Skin biopsy17

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
120641CAMDMarriage & Family Therapist
L-239279MAMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Stanford Health Care CurrentSince Sep 5, 2012 Accepting new patients
Stanford Health Care Dermatology CurrentSince Sep 5, 2012 Accepting new patients
Stanford Health Care Dermatology Current Accepting new patients
Lucile Salter Packard Children's Hospital at Stanford Past Accepting new patients
Stanford Hospital and Clinics Past Accepting new patients

Locations

900 Blake Wilbur Dr
Palo Alto, CA 94304
Phone (650) 498-6004

450 Broadway St
Redwood City, CA 94063
Phone (650) 723-5643

450 Broadway St
Fl 2
Redwood City, CA 94063
Phone (650) 498-3931

300 Pasteur Dr
Stanford, CA 94305
Phone (650) 498-5710

Interoperability endpoints

  • Direct secure messaging: jko74214@direct.stanfordhealthcare.org

Organizations & group practices 5

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.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1244678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713225600000",
    "number": "1790912251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "440 BROADWAY ST FL B4",
            "city": "REDWOOD CITY",
            "state": "CA",
            "postal_code": "940633123",
            "telephone_number": "650-723-6316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 PASTEUR DR",
            "city": "STANFORD",
            "state": "CA",
            "postal_code": "943052200",
            "telephone_number": "650-723-4000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "440 Broadway St Fl B4",
            "address_purpose": "LOCATION",
            "city": "Redwood City",
            "state": "CA",
            "postal_code": "940633123",
            "country_code": "US",
            "telephone_number": "650-723-6316",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KO",
        "first_name": "JUSTIN",
        "middle_name": "MENG",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-11",
        "last_updated": "2024-04-16",
        "certification_date": "2024-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MA",
            "license": "L-239279",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "A120641",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stanford, CA

Sources for this page

Verify at the official NPI Registry.