Provider Demographics
NPI:1114649852
Name:KOH, YOUNG GEON (PSYD)
Entity Type:Individual
Prefix:
First Name:YOUNG GEON
Middle Name:
Last Name:KOH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:YOUNG
Other - Middle Name:
Other - Last Name:KOH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:625 W COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-5283
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:625 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-5283
Practice Address - Country:US
Practice Address - Phone:469-252-7090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38872103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist