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NPI Code Detail

MEDICARE: CARLYN YEONG SOOK KO M.D.

MEDICARE: CARLYN YEONG SOOK KO 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
1207P00000XEmergency Medicine Physician35083978KOH

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00290024OTHEROHMEDICARE RAIL ROAD
2P00105509OTHERRAIL ROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4000000372342OTHEROHANTHEM/BCBS
5000000326463OTHEROHBCBS

General Provider Information

NPI Number : 1487612974
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARLYN YEONG SOOK KO M.D.
Provider Business Mailing Address
First Line : 4750 HEMPSTEAD STATION DR
Second Line :
City : KETTERING
State : OH
Zip : 45429-5164
Country : US
Telephone Number : 800-875-0136
Fax Number : 937-619-4231
Provider Business Practice Location Address
First Line : 630 EATON AVE
Second Line :
City : HAMILTON
State : OH
Zip : 45013-2767
Country : US
Telephone Number : 513-867-2270
Fax Number : 513-867-2581
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2006
Last Update Date : 05/21/2008

Similar Medicare Providers

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Practice Location Address:
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1730174087 — HOSPITALIST SERVICES MEDICAL GROUP OF HAMILTON, INC.
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1457319386 — ANTHONY JASSEIM ABDULLAH M.D.
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1124076336 — GHAZALA SADRUDDIN MALIK M.D.
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1942258025 — ROBERT EDWIN BEHRENDT M.D.
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Directions to “ CARLYN YEONG SOOK KO M.D.” Practice Location

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