Healthcare Provider Details

I. General information

NPI: 1457533648
Provider Name (Legal Business Name): YUNG K KHO MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 NE 6TH STREET
GRANTS PASS OR
97526-1494
US

IV. Provider business mailing address

1601 NE 6TH STREET
GRANTS PASS OR
97526-1494
US

V. Phone/Fax

Practice location:
  • Phone: 541-474-5071
  • Fax: 541-476-0866
Mailing address:
  • Phone: 541-474-5071
  • Fax: 541-476-0866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD12912
License Number StateOR

VIII. Authorized Official

Name: DR. YUNG K KHO
Title or Position: OWNER
Credential: MD
Phone: 541-474-5071