Provider Demographics
NPI:1437448917
Name:KO, KIMBERLY JAMIE (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:JAMIE
Last Name:KO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 WEDGEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-1659
Mailing Address - Country:US
Mailing Address - Phone:818-842-0475
Mailing Address - Fax:
Practice Address - Street 1:3450 WEDGEWOOD LN
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91504-1659
Practice Address - Country:US
Practice Address - Phone:818-842-0475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77120208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics