Individual
SAMUEL KO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
600 COFFEE RD, MODESTO, CA 95355-4201
(209) 833-2367
Mailing address
600 COFFEE RD, MODESTO, CA 95355-4201
(209) 521-6097
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A 78138
CA
208M00000X
Hospitalist Physician
Primary
A78138
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00C516670
MEDI-CAL PROVIDER NUMBER
CA
Enumeration date
02/09/2007
Last updated
07/21/2022
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