MEDICARE: LYDIA S. KO

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1417070582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYDIA S. KO

Provider Business Mailing Address
First Line	:	18623 GALE AVE
Second Line	:
City	:	CITY OF INDUSTRY
State	:	CA
Zip	:	91748-1342
Country	:	US
Telephone Number	:	626-839-0300
Fax Number	:	626-839-1780

Provider Business Practice Location Address
First Line	:	18623 GALE AVE
Second Line	:
City	:	CITY OF INDUSTRY
State	:	CA
Zip	:	91748-1342
Country	:	US
Telephone Number	:	626-839-0300
Fax Number	:	626-839-1780

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

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	01/19/2017

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