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General NPI Number Information
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NPI Number | 1487612974
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Entity Type | Individual
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Provider Name | CARLYN YEONG SOOK KO M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 05/21/2008
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Provider Practice Location Address
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Address Line | 630 EATON AVE
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City | HAMILTON
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State | OH
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Zip | 45013-2767
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Country | US
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Telephone | 513-867-2270
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Fax | 513-867-2581
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Provider Business Mailing Address
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Address Line | 4750 HEMPSTEAD STATION DR
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City | KETTERING
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State | OH
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Zip | 45429-5164
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Country | US
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Telephone | 800-875-0136
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Fax | 937-619-4231
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 35083978K
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License Number State | OH
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