Provider Demographics
NPI:1225187131
Name:KO, JARRET HC (MD)
Entity Type:Individual
Prefix:DR
First Name:JARRET
Middle Name:HC
Last Name:KO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1188 BISHOP ST STE 2603
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-3310
Mailing Address - Country:US
Mailing Address - Phone:808-531-6611
Mailing Address - Fax:
Practice Address - Street 1:1188 BISHOP ST STE 2603
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-3310
Practice Address - Country:US
Practice Address - Phone:808-531-6611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD 1919101YM0800X
HIMD 1919174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI3347-2Medicaid
HI3347-2Medicaid