Provider Demographics
NPI:1043356470
Name:KOO, JOHN JAH-HYUN (MD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:JAH-HYUN
Last Name:KOO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JAH-HYUN
Other - Middle Name:
Other - Last Name:KOO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3600 N. INTERSTATE AVENUE
Mailing Address - Street 2:DEPARTMENT OF OPTHALMOLOGY
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227
Mailing Address - Country:US
Mailing Address - Phone:503-331-6330
Mailing Address - Fax:503-571-5877
Practice Address - Street 1:3600 N. INTERSTATE AVENUE
Practice Address - Street 2:DEPARTMENT OF OPTHALMOLOGY
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227
Practice Address - Country:US
Practice Address - Phone:503-331-6330
Practice Address - Fax:503-571-5877
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0066681207W00000X
ORMD151394207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology