Healthcare Provider Details

I. General information

NPI: 1982602181
Provider Name (Legal Business Name): YIH-SHYONG KO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: YIH SHYONG KO M.D.

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 10/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 N 12TH ST
LEHIGHTON PA
18235-1138
US

IV. Provider business mailing address

PO BOX 650782
DALLAS TX
75265-0782
US

V. Phone/Fax

Practice location:
  • Phone: 215-442-5085
  • Fax: 877-329-2370
Mailing address:
  • Phone: 302-733-0806
  • Fax: 302-733-0854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD036519L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0004958310036
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
IdentifierP00692009
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerRAILROAD MEDICARE
# 3
Identifier000667281
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: