Provider Demographics
NPI:1295166288
Name:KOO, BYUNGKI
Entity type:Individual
Prefix:
First Name:BYUNGKI
Middle Name:
Last Name:KOO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3710 149TH PL APT 1B
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4964
Mailing Address - Country:US
Mailing Address - Phone:718-820-6911
Mailing Address - Fax:718-321-2050
Practice Address - Street 1:3710 149TH PL APT 1B
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4964
Practice Address - Country:US
Practice Address - Phone:718-820-6911
Practice Address - Fax:718-321-2050
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home