DR. KELLY HWA KOO PH.D.
NPI 1740521970
Psychologist - Clinical in San Bruno, CA

Q: What is Kelly Koo's NPI number?

The NPI number for Kelly Koo is 1740521970. It was assigned to this individual provider in the NPPES registry on March 13, 2013.

Q: What is Kelly Koo's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Q: Is Kelly Koo enrolled in Medicare?

No. Kelly Koo has opted out of Medicare through January 24, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

Q: When was this NPI record last updated?

The NPPES record for Kelly Koo was last updated on January 5, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since March 13, 2013Opted out of Medicare · through Jan 24, 2028

1001 SNEATH LN, SUITE 300, SAN BRUNO, CA 94066(650) 615-6075 Get Directions Write a Review

NPPES record last updated: January 5, 2016. Verified against the NPPES registry weekly; last sync: August 23, 2026.

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About Dr. Kelly Hwa Koo Ph.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. KELLY HWA KOO PH.D. (NPI 1740521970) is an individual clinical provider in San Bruno, California, licensed in California (PSY27845) and active in the NPI registry since March 2013. She has opted out of Medicare through January 24, 2028.

NPPES Registry Identity

NPI1740521970

Entity TypeIndividualFemale

Primary Taxonomy103TC0700X

Provider Legal NameDR. KELLY HWA KOOCredential: PH.D.

Location Address1001 SNEATH LN, SUITE 300San Bruno, CA 94066-2308

Mailing Address1001 Sneath Ln, Suite 300San Bruno, CA 94066-2308 · (650) 615-6075

Phone(650) 615-6075

Sole ProprietorNo

Enumeration DateMarch 13, 2013

Last NPPES UpdateJanuary 5, 2016

✔ NPI 1740521970 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code103TC0700X

License✔ Licensed in CA · PSY27845

Definition

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X

1001 SNEATH LN, San Bruno, CA 94066

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Kelly Hwa Koo Ph.d. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from January 24, 2022 through January 24, 2028.

Opt-Out Effective DateJanuary 24, 2022

Opt-Out In Effect ThroughJanuary 24, 2028Opt-out affidavits renew automatically every two years unless cancelled

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 94066 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$202.35 typical visit price

range $69.00 – $202.35

Typical copayment $50.58 (range $17.25 – $50.58)

Most-billed visit code 99205

Established Patient

$119.48 typical visit price

range $23.44 – $166.46

Typical copayment $29.87 (range $5.86 – $41.61)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DAPHNEY FULGENCIO

Behavior Technician

1001 SNEATH LN
SAN BRUNO, CA 94066

San Mateo County (650) 243-9849

LAURA BRECKENRIDGE NP

Internal Medicine (Sports Medicine)

1001 SNEATH LN, SUITE 104
SAN BRUNO, CA 94066

San Mateo County (650) 873-4545

MARIFE ROSANNA S. TOLENTINO MD

Pediatrics

1001 SNEATH LN, STE 104
SAN BRUNO, CA 94066

San Mateo County (650) 873-4545

DR. SUSAN E SALES DDS

Dentist (General Practice)

1001 SNEATH LN, SUITE 108
SAN BRUNO, CA 94066

San Mateo County (650) 871-2741

SAN FRANCISCO VAMC

Clinic/Center (VA)

1001 SNEATH LN, SUITE 300
SAN BRUNO, CA 94066

San Mateo County (702) 341-3020

MRS. DINA R JENKINS RDA

Counselor (Addiction (Substance Use Disorder))

1001 SNEATH LN
SAN BRUNO, CA 94066

San Mateo County (650) 244-1444

DR. NATHAN EWIGMAN

Psychologist (Clinical)

1001 SNEATH LN
SAN BRUNO, CA 94066

San Mateo County (650) 615-6050

DR. EMJAY MENG-JIAO TAN M.D.

Psychiatry & Neurology (Addiction Psychiatry)

1001 SNEATH LN, SUITE 204
SAN BRUNO, CA 94066

San Mateo County (650) 616-6200

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kelly Koo's NPI number?

The NPI number for Kelly Koo is 1740521970. It was assigned to this individual provider in the NPPES registry on March 13, 2013.

Where is Kelly Koo located?

Kelly Koo practices at 1001 Sneath Ln Suite 300, San Bruno, CA 94066. The listed phone number is (650) 615-6075.

What is Kelly Koo's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Is Kelly Koo enrolled in Medicare?

No. Kelly Koo has opted out of Medicare through January 24, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Kelly Koo was last updated on January 5, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.