Basic Information
| Provider Information | |||||||||
| NPI: | 1639216732 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | YONG KYOO KOH, M.D., INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 800817 | ||||||||
| Address2: | |||||||||
| City: | SANTA CLARITA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913800817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612950859 | ||||||||
| FaxNumber: | 6612950862 | ||||||||
| Practice Location | |||||||||
| Address1: | 1154 N EUCLID ST | ||||||||
| Address2: | |||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928011955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7146356272 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | KOH | ||||||||
| AuthorizedOfficialFirstName: | YONG | ||||||||
| AuthorizedOfficialMiddleName: | KYOO | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7143748464 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | C50260 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | P00115913 | 01 | CA | RAILROAD MEDICARE ID# | OTHER | 00C502600 | 05 | CA | MEDICAID |