Provider Demographics
NPI:1083798607
Name:KYOO S, RO, M.D., INC.
Entity Type:Organization
Organization Name:KYOO S, RO, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KYOO
Authorized Official - Middle Name:S
Authorized Official - Last Name:RO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-240-5241
Mailing Address - Street 1:435 ARDEN AVE
Mailing Address - Street 2:SUITE 380
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-1130
Mailing Address - Country:US
Mailing Address - Phone:818-240-5241
Mailing Address - Fax:818-240-8264
Practice Address - Street 1:435 ARDEN AVE
Practice Address - Street 2:#380
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1130
Practice Address - Country:US
Practice Address - Phone:818-240-5241
Practice Address - Fax:818-240-8264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26079207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A26079Medicaid
CAA83322Medicare UPIN
CAA26079Medicare ID - Type Unspecified