MEDICARE: KYOO SANG RO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician	A26079A	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083613897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYOO SANG RO M.D.

Provider Business Mailing Address
First Line	:	435 ARDEN AVE
Second Line	:	SUITE 380
City	:	GLENDALE
State	:	CA
Zip	:	91203-1130
Country	:	US
Telephone Number	:	818-240-5241
Fax Number	:	818-240-8264

Provider Business Practice Location Address
First Line	:	435 ARDEN AVE
Second Line	:	380
City	:	GLENDALE
State	:	CA
Zip	:	91203-1130
Country	:	US
Telephone Number	:	818-240-5241
Fax Number	:	818-240-8264

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	11/16/2011

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Directions to “ KYOO SANG RO M.D.” Practice Location

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