Provider Demographics
NPI:1518928829
Name:KOK, YIH JEN (MD)
Entity Type:Individual
Prefix:DR
First Name:YIH
Middle Name:JEN
Last Name:KOK
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 1:506 W VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-3731
Mailing Address - Country:US
Mailing Address - Phone:626-308-3800
Mailing Address - Fax:626-308-1899
Practice Address - Street 1:506 W VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3731
Practice Address - Country:US
Practice Address - Phone:626-308-3800
Practice Address - Fax:626-308-1899
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71806207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A718060Medicaid
CA00A718060OtherBLUE SHIELD OF CA
CA11549078OtherCAQH
CARHC148914OtherFLOURO/XRAY SUPERVISOR
CAH50678Medicare UPIN
CARHC148914OtherFLOURO/XRAY SUPERVISOR