Provider Demographics
NPI:1265466551
Name:KO, CHRISTINE YANG (MD)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:YANG
Last Name:KO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:CHRISTINE
Other - Middle Name:YANG
Other - Last Name:KO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6699 ALVARADO RD
Mailing Address - Street 2:STE 2100
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-5238
Mailing Address - Country:US
Mailing Address - Phone:619-229-3909
Mailing Address - Fax:619-229-3902
Practice Address - Street 1:6699 ALVARADO RD
Practice Address - Street 2:SUITE 2100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-5238
Practice Address - Country:US
Practice Address - Phone:619-229-3909
Practice Address - Fax:619-229-3902
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91210207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACZ398ZOtherINDIVIDUAL PTAN
CAW12026OtherGROUP PTAN