=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457533648
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YUNG K KHO MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2007
-----------------------------------------------------
Last Update Date | 11/29/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1601 NE 6TH STREET
-----------------------------------------------------
City | GRANTS PASS
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97526-1494
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-474-5071
-----------------------------------------------------
Fax | 541-476-0866
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1601 NE 6TH STREET
-----------------------------------------------------
City | GRANTS PASS
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97526-1494
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-474-5071
-----------------------------------------------------
Fax | 541-476-0866
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. YUNG K KHO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 541-474-5071
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | MD12912
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------