Provider Demographics
NPI:1083604219
Name:KO, DICKEN SHIU-CHUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:DICKEN
Middle Name:SHIU-CHUNG
Last Name:KO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:75 NEWMAN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:RUMFORD
Mailing Address - State:RI
Mailing Address - Zip Code:02916-3603
Mailing Address - Country:US
Mailing Address - Phone:401-854-2465
Mailing Address - Fax:
Practice Address - Street 1:2 DUDLEY ST STE 175
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-3246
Practice Address - Country:US
Practice Address - Phone:401-421-0710
Practice Address - Fax:401-421-0796
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT042.0012769204F00000X
MA79821208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA079821OtherTUFTS HEALTH PLAN
MA3164845Medicaid
MAJ17470OtherBCBS MA
G43799Medicare UPIN
MAJ17470OtherBCBS MA