Provider Demographics
NPI:1053452763
Name:KO, DOUG C (LAC)
Entity Type:Individual
Prefix:
First Name:DOUG
Middle Name:C
Last Name:KO
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
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Mailing Address - Street 1:4816 SIX FORKS RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609
Mailing Address - Country:US
Mailing Address - Phone:919-803-2424
Mailing Address - Fax:919-803-2193
Practice Address - Street 1:4816 SIX FORKS RD
Practice Address - Street 2:SUITE 102
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609
Practice Address - Country:US
Practice Address - Phone:919-803-2424
Practice Address - Fax:919-803-2193
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAAC786171100000X
WA786171100000X
NC935171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist