Provider Demographics
NPI:1790108546
Name:CHI K. CO, M.D., INC.
Entity Type:Organization
Organization Name:CHI K. CO, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHI
Authorized Official - Middle Name:K
Authorized Official - Last Name:CO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-808-9858
Mailing Address - Street 1:161 S SPRUCE AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-4517
Mailing Address - Country:US
Mailing Address - Phone:650-808-9858
Mailing Address - Fax:650-808-9868
Practice Address - Street 1:161 S SPRUCE AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-4517
Practice Address - Country:US
Practice Address - Phone:650-808-9858
Practice Address - Fax:650-808-9868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49311174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty