Jenny Koo, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

A139737 Issued in CA

Practice address

3003 Health Center Dr
San Diego, CA 92123-2700

Phone

(858) 939-4185

Fax

(858) 939-4972

NPI assigned

Apr 1, 2014

Last updated

May 20, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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

• San Diego Pediatric Neurology, Inc.

  • Neurology Physician
  • San Diego, CA
  • NPI 1306433032
  NPD
• San Diego Neonatology, Inc.

  • Neonatal-Perinatal Medicine Physician
  • San Diego, CA
  • NPI 1356585954
  NPD (past)

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

{
    "created_epoch": "1396310400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621468800000",
    "number": "1851719413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8555 AERO DR STE 340",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921231740",
            "telephone_number": "858-939-4185",
            "fax_number": "858-939-4972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3003 HEALTH CENTER DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921232700",
            "telephone_number": "858-939-4185",
            "fax_number": "858-939-4972"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOO",
        "first_name": "JENNY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-01",
        "last_updated": "2021-05-20",
        "certification_date": "2021-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A139737",
            "primary": true
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "CA",
            "license": "A139737",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cynthia Konow-Brownell, MA, CCC-SLP
• Christy Michele Konow
• Toula Kontaxis, RPH
• Jennifer Konzen, PSY.D.
• Katherine Mary Konzen, M.D.
• Kyung Mo Koo, PHARMD
• Rebecca Koo, LMFT
• Cassandra Kooiker, MD, PHD
• Elaine Kooima, RN
• Eloise Kae Kooima

• Pediatrics Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2021; 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.

Verify at the official NPI Registry.