Provider Demographics
NPI:1598867186
Name:KO, ALMIRA (DPM)
Entity Type:Individual
Prefix:DR
First Name:ALMIRA
Middle Name:
Last Name:KO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 91217
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97291-0217
Mailing Address - Country:US
Mailing Address - Phone:503-466-1210
Mailing Address - Fax:503-466-2791
Practice Address - Street 1:3586 NW 112TH PL
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-4585
Practice Address - Country:US
Practice Address - Phone:503-446-1210
Practice Address - Fax:503-466-2791
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00294213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORU74456Medicare UPIN
OR131604Medicare PIN
OR131605Medicare PIN