Healthcare Provider Details

I. General information

NPI: 1689134751
Provider Name (Legal Business Name): JU YONG KOH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2019
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1231 116TH AVE NE BLDG 5
BELLEVUE WA
98004-3804
US

IV. Provider business mailing address

1231 116TH AVE NE BLDG 5 SUITE 950
BELLEVUE WA
98004-3804
US

V. Phone/Fax

Practice location:
  • Phone: 425-454-3366
  • Fax:
Mailing address:
  • Phone: 425-454-3366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberDO.OP.70121943-IMLC
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: