Provider Demographics
NPI:1225482532
Name:KOO, RACHEL
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:KOO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SUMMERLIN HOSPITAL MEDICAL CENTER
Mailing Address - Street 2:657 N TOWN CENTER DRIVE
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144
Mailing Address - Country:US
Mailing Address - Phone:702-233-7499
Mailing Address - Fax:702-233-7406
Practice Address - Street 1:SUMMERLIN HOSPITAL MEDICAL CENTER
Practice Address - Street 2:657 N TOWN CENTER DRIVE
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144
Practice Address - Country:US
Practice Address - Phone:702-233-7499
Practice Address - Fax:702-233-7406
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-22
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA156243208000000X
CA390200000X
NV229982080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program