Provider Demographics
NPI:1861579690
Name:KO, JAMES LEE (PT)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:LEE
Last Name:KO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:PO BOX 79396
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92877-0179
Mailing Address - Country:US
Mailing Address - Phone:714-724-2681
Mailing Address - Fax:866-319-7682
Practice Address - Street 1:25389 MADISON AVE
Practice Address - Street 2:STE. 101
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-9006
Practice Address - Country:US
Practice Address - Phone:951-600-7900
Practice Address - Fax:951-600-7908
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPT21868225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT21868Medicare ID - Type Unspecified