MEDICARE: MRS. CHRISTINE YANG KO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	A91210	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CZ398Z	OTHER	CA	INDIVIDUAL PTAN
2	W12026	OTHER	CA	GROUP PTAN

General Provider Information

NPI Number	:	1265466551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTINE YANG KO MD

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

Provider Business Practice Location Address
First Line	:	6699 ALVARADO RD
Second Line	:	SUITE 2100
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-5238
Country	:	US
Telephone Number	:	619-229-3909
Fax Number	:	619-229-3902

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	11/11/2011

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