1285847699 NPI number — TIMOTHY YEE-TAK KO MD

Table of content: TIMOTHY YEE-TAK KO MD (NPI 1285847699)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285847699 NPI number — TIMOTHY YEE-TAK KO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KO
Provider First Name:
TIMOTHY
Provider Middle Name:
YEE-TAK
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285847699
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2374 VILLAGE COMMON DR STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ERIE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16506-7201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-833-7246
Provider Business Mailing Address Fax Number:
814-833-1147

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2374 VILLAGE COMMON DR STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ERIE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16506-7201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-833-7246
Provider Business Practice Location Address Fax Number:
814-833-1147
Provider Enumeration Date:
05/08/2007

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: 208VP0014X , with the licence number:  MD462767 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0014X , with the licence number: 35.087753 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1023171040002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2769311 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003665938 . This is a "HIGHMARK" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com