Provider Demographics
NPI:1457350985
Name:KOO, JOSEPH K (MD)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:K
Last Name:KOO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 57
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96810-0057
Mailing Address - Country:US
Mailing Address - Phone:808-836-3303
Mailing Address - Fax:808-836-3303
Practice Address - Street 1:321 N. KUAKINI STREET, SUITE 715
Practice Address - Street 2:KUAKINI MEDICAL PLAZA
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817
Practice Address - Country:US
Practice Address - Phone:808-523-6461
Practice Address - Fax:808-550-0466
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2023-12-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIMD-6718207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI055439-01Medicaid
HI0000BDQJTMedicare ID - Type Unspecified
HI055439-01Medicaid