Provider Demographics
NPI:1841364841
Name:KO, EDWARD K (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:K
Last Name:KO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 PLYMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-1244
Mailing Address - Country:US
Mailing Address - Phone:415-956-9823
Mailing Address - Fax:415-889-6988
Practice Address - Street 1:818 JACKSON ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94133-4849
Practice Address - Country:US
Practice Address - Phone:415-956-9823
Practice Address - Fax:415-889-6988
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61149207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G67074Medicare UPIN