Provider Demographics
NPI:1093778482
Name:KOH, HOWARD KYONGJU (MD MPH)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:KYONGJU
Last Name:KOH
Suffix:
Gender:M
Credentials:MD MPH
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Mailing Address - Street 1:677 HUNTINGTON AVE
Mailing Address - Street 2:LANDMARK CENTER 3RD FLOOR EAST
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-3325
Mailing Address - Country:US
Mailing Address - Phone:617-495-4000
Mailing Address - Fax:617-495-8543
Practice Address - Street 1:715 ALBANY ST
Practice Address - Street 2:J-100
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2526
Practice Address - Country:US
Practice Address - Phone:617-638-5500
Practice Address - Fax:617-638-5515
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-08
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA44564207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3001768Medicaid
B74559Medicare UPIN
MA3001768Medicaid