Provider Demographics
NPI:1669208112
Name:KOO, SHUK KWAN
Entity type:Individual
Prefix:MS
First Name:SHUK
Middle Name:KWAN
Last Name:KOO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROSEMARY
Other - Middle Name:
Other - Last Name:KOO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:134 W 58TH ST APT 707
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-2160
Mailing Address - Country:US
Mailing Address - Phone:917-294-3761
Mailing Address - Fax:
Practice Address - Street 1:550 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6402
Practice Address - Country:US
Practice Address - Phone:212-263-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY123734104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker