Basic Information
| Provider Information | |||||||||
| NPI: | 1891997011 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KO | ||||||||
| FirstName: | IRIS | ||||||||
| MiddleName: | PARK | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4280 VIA ARBOLADA | ||||||||
| Address2: | UNIT 223 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900425074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7147242756 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 75 NEILSON ST | ||||||||
| Address2: | |||||||||
| City: | WATSONVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95076 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8317244741 | ||||||||
| FaxNumber: | 8317636069 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2007 | ||||||||
| LastUpdateDate: | 08/03/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 258895 | NY | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 2010004025 | MO | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | A110533 | CA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.