Provider Demographics
NPI:1376981886
Name:MO, KYOUNG O (RN)
Entity Type:Individual
Prefix:
First Name:KYOUNG
Middle Name:O
Last Name:MO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 HANSEN CIR
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630
Mailing Address - Country:US
Mailing Address - Phone:408-497-5451
Mailing Address - Fax:
Practice Address - Street 1:355 HANSEN CIR
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630
Practice Address - Country:US
Practice Address - Phone:408-497-5451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA715696163WN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0300XNursing Service ProvidersRegistered NurseNephrology