Provider Demographics
NPI:1083805154
Name:OO HYON KYONG, MD
Entity Type:Organization
Organization Name:OO HYON KYONG, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OO
Authorized Official - Middle Name:HYON
Authorized Official - Last Name:KYONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-273-4331
Mailing Address - Street 1:1290 TRUMANSBURG RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1314
Mailing Address - Country:US
Mailing Address - Phone:607-273-4331
Mailing Address - Fax:607-272-0257
Practice Address - Street 1:1290 TRUMANSBURG RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1314
Practice Address - Country:US
Practice Address - Phone:607-273-4331
Practice Address - Fax:607-272-0257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY122217207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02432891Medicaid
NY02432891Medicaid