Provider Demographics
NPI:1922209188
Name:CASE WESTERN RESERVE UNIVERSITY
Entity Type:Organization
Organization Name:CASE WESTERN RESERVE UNIVERSITY
Other - Org Name:LOUIS STOKES VA HOSPTIAL
Other - Org Type:Other Name
Authorized Official - Title/Position:FELLOW
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:BON-JEONG
Authorized Official - Last Name:KOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-791-3800
Mailing Address - Street 1:1300 W 9TH ST
Mailing Address - Street 2:APT 807
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-1031
Mailing Address - Country:US
Mailing Address - Phone:718-813-9422
Mailing Address - Fax:216-707-5972
Practice Address - Street 1:10701 EAST BLVD
Practice Address - Street 2:K-216
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1702
Practice Address - Country:US
Practice Address - Phone:216-791-3800
Practice Address - Fax:216-707-5972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.087275282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital