Individual provider Active NPI

John Jung Gill Koh, MD

  • Obstetrics & Gynecology Physician
  • Simi Valley, CA
National Provider Identifier
1841283009
Registry record updated Jun 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
A31915 Issued in CA
Practice address
1147 Red Tail Way
Simi Valley, CA 93065-7232
Phone
(805) 527-8055
Fax
(805) 520-8849
NPI assigned
Aug 23, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X A31915 CA Primary

Addresses

Primary practice location

1147 Red Tail Way
Simi Valley, CA 93065-7232

Mailing address

1147 Red Tail Way
Simi Valley, CA 93065-7232
Phone (805) 527-8055

Other identifiers 1

IdentifierTypeStateIssuer
00A319151MedicaidCA

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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110127000887 CA Practitioner - Obstetrics/Gynecology 6103806369 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A31915CAMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Simi Obstetrics & Gynecology Medical Group a Medical Corp. Obstetrics & Gynecology CurrentSince Oct 17, 2000 Accepting new patients

Locations

1147 Red Tail Way
Simi Valley, CA 93065
Phone (805) 527-8055

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1124755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340755200000",
    "number": "1841283009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1147 RED TAIL WAY",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930657232",
            "telephone_number": "805-527-8055",
            "fax_number": "805-520-8849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1147 RED TAIL WAY",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930657232",
            "telephone_number": "805-527-8055",
            "fax_number": "805-520-8849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOH",
        "first_name": "JOHN",
        "middle_name": "JUNG GILL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-23",
        "last_updated": "2012-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "CA",
            "license": "A31915",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A319151",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Simi Valley, CA

Sources for this page

Verify at the official NPI Registry.