Provider Demographics
NPI:1780847681
Name:KOO, MICHAEL HOSUNG (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:HOSUNG
Last Name:KOO
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 1:16651 SOUTHWEST FREEWAY MOB1
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479
Mailing Address - Country:US
Mailing Address - Phone:713-776-9500
Mailing Address - Fax:713-776-3087
Practice Address - Street 1:16651 SOUTHWEST FREEWAY MOB1
Practice Address - Street 2:SUITE 400
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479
Practice Address - Country:US
Practice Address - Phone:713-776-9500
Practice Address - Fax:713-776-3087
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60260642207R00000X
NY260642207RC0000X
TXQ6439207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8FN845OtherBLUE CROSS BLUE SHIELD
TX462609YQ64Medicare PIN
TX8FN845OtherBLUE CROSS BLUE SHIELD