1265466551 NPI number — MRS. CHRISTINE YANG KO MD

Table of content: MRS. CHRISTINE YANG KO MD (NPI 1265466551)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265466551 NPI number — MRS. CHRISTINE YANG KO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KO
Provider First Name:
CHRISTINE
Provider Middle Name:
YANG
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KO
Provider Other First Name:
CHRISTINE
Provider Other Middle Name:
YANG
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1265466551
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6699 ALVARADO RD
Provider Second Line Business Mailing Address:
STE 2100
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92120-5238
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-229-3909
Provider Business Mailing Address Fax Number:
619-229-3902

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6699 ALVARADO RD
Provider Second Line Business Practice Location Address:
SUITE 2100
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92120-5238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-229-3909
Provider Business Practice Location Address Fax Number:
619-229-3902
Provider Enumeration Date:
07/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  A91210 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CZ398Z . This is a "INDIVIDUAL PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: W12026 . This is a "GROUP PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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