Basic Information
| Provider Information | |||||||||
| NPI: | 1265466551 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KO | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | YANG | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KO | ||||||||
| OtherFirstName: | CHRISTINE | ||||||||
| OtherMiddleName: | YANG | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6699 ALVARADO RD | ||||||||
| Address2: | STE 2100 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921205238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192293909 | ||||||||
| FaxNumber: | 6192293902 | ||||||||
| Practice Location | |||||||||
| Address1: | 6699 ALVARADO RD | ||||||||
| Address2: | SUITE 2100 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921205238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192293909 | ||||||||
| FaxNumber: | 6192293902 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 11/11/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A91210 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | CZ398Z | 01 | CA | INDIVIDUAL PTAN | OTHER | W12026 | 01 | CA | GROUP PTAN | OTHER |