Provider Demographics
NPI:1003841693
Name:KO, RICHARD H (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:H
Last Name:KO
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Gender:M
Credentials:MD
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Mailing Address - Street 1:6430 W SUNSET BLVD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-7901
Mailing Address - Country:US
Mailing Address - Phone:323-361-2337
Mailing Address - Fax:323-361-8491
Practice Address - Street 1:4650 W SUNSET BLVD
Practice Address - Street 2:MAILSTOP #54
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6016
Practice Address - Country:US
Practice Address - Phone:323-361-6497
Practice Address - Fax:323-361-7128
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2009-08-31
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Provider Licenses
StateLicense IDTaxonomies
CAA91662208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A916620Medicaid
CA00A916620Medicare PIN