Provider Demographics
NPI:1477596864
Name:KOO, HELEN C (MD)
Entity Type:Individual
Prefix:DR
First Name:HELEN
Middle Name:C
Last Name:KOO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:HELEN
Other - Middle Name:S
Other - Last Name:KOO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:265 E BEVERLY BLVD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-3776
Mailing Address - Country:US
Mailing Address - Phone:323-721-4922
Mailing Address - Fax:323-721-3484
Practice Address - Street 1:265 E BEVERLY BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-3776
Practice Address - Country:US
Practice Address - Phone:323-721-4922
Practice Address - Fax:323-721-3484
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26756174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A267560Medicaid