Provider Demographics
NPI:1215019492
Name:PAUL KO PT
Entity Type:Organization
Organization Name:PAUL KO PT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:HYUN KO
Authorized Official - Middle Name:
Authorized Official - Last Name:KYONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-445-3370
Mailing Address - Street 1:14340 38TH AVE
Mailing Address - Street 2:# 204
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5759
Mailing Address - Country:US
Mailing Address - Phone:718-445-4370
Mailing Address - Fax:718-445-4378
Practice Address - Street 1:14340 38TH AVE
Practice Address - Street 2:# 204
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5759
Practice Address - Country:US
Practice Address - Phone:718-445-4370
Practice Address - Fax:718-445-4378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023722207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ05141Medicare UPIN
NY07830Medicare PIN