Provider Demographics
NPI:1417068081
Name:KO, WEI-FANG (MD)
Entity Type:Individual
Prefix:
First Name:WEI-FANG
Middle Name:
Last Name:KO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19845 LAKE CHABOT RD
Mailing Address - Street 2:SUITE, 104
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-4055
Mailing Address - Country:US
Mailing Address - Phone:510-537-4415
Mailing Address - Fax:
Practice Address - Street 1:19845 LAKE CHABOT RD
Practice Address - Street 2:SUITE, 104
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-4055
Practice Address - Country:US
Practice Address - Phone:510-537-4415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62022207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ25407ZOtherSERVICE LOCATIONS WITH ZIP 94545
CAZZZ25408ZOtherSERVICE LOCATION ZIPCODE 94546 AND 94541