Provider Demographics
NPI:1437174323
Name:KO, TINA Y (DO)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:Y
Last Name:KO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 E NORTH AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4756
Mailing Address - Country:US
Mailing Address - Phone:412-359-3319
Mailing Address - Fax:412-359-4136
Practice Address - Street 1:320 E NORTH AVE FL 4
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4756
Practice Address - Country:US
Practice Address - Phone:412-359-3319
Practice Address - Fax:412-359-4136
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012345207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001895755Medicaid
PA059101NJ3Medicare PIN
PAH66672Medicare UPIN
PACG2169Medicare PIN
PAP00340166Medicare PIN
PAH66672Medicare UPIN
WV3810006689Medicaid