Provider Demographics
NPI:1033515671
Name:KO, VINCENT GEE LUM (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:GEE LUM
Last Name:KO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 TWINVIEW PL
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-3568
Mailing Address - Country:US
Mailing Address - Phone:808-389-0086
Mailing Address - Fax:
Practice Address - Street 1:1526 PALOS VERDES MALL
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94597-2229
Practice Address - Country:US
Practice Address - Phone:808-389-0086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA71914183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist