Healthcare Provider Details

I. General information

NPI: 1932143963
Provider Name (Legal Business Name): DAVID Y. KO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11201 BENTON ST # 2A-205
LOMA LINDA CA
92357-5310
US

IV. Provider business mailing address

3240 LOMBARDY RD
PASADENA CA
91107-5533
US

V. Phone/Fax

Practice location:
  • Phone: 909-825-7084
  • Fax: 909-777-3814
Mailing address:
  • Phone: 323-697-9802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License NumberG81872
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberG81872
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberG81872
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: