Provider Demographics
NPI:1003995713
Name:KO, TAK MING (MD)
Entity Type:Individual
Prefix:
First Name:TAK MING
Middle Name:
Last Name:KO
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:2480 S WOODWORTH LOOP
Mailing Address - Street 2:STE 180
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-7408
Mailing Address - Country:US
Mailing Address - Phone:907-373-8281
Mailing Address - Fax:855-212-0736
Practice Address - Street 1:2480 S WOODWORTH LOOP STE 180
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-7408
Practice Address - Country:US
Practice Address - Phone:907-373-8281
Practice Address - Fax:855-212-0736
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK6953208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1019943Medicaid
AKBK6625365OtherDEA