Provider Demographics
NPI:1861411324
Name:KO, DERECK H (MSN)
Entity type:Individual
Prefix:MR
First Name:DERECK
Middle Name:H
Last Name:KO
Suffix:
Gender:M
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1671 EDGEHILL CT
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-6301
Mailing Address - Country:US
Mailing Address - Phone:415-353-2421
Mailing Address - Fax:415-353-2467
Practice Address - Street 1:400 PARNASSUS AVE # A502
Practice Address - Street 2:UCSF MEDICAL CENTER
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0324
Practice Address - Country:US
Practice Address - Phone:415-353-2421
Practice Address - Fax:415-353-2467
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA538312163W00000X
CA15088363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily