Provider Demographics
NPI:1609207281
Name:KO, RYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:KO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:LWIN
Other - Middle Name:KO
Other - Last Name:KO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:45 E RIVER PARK PL W STE 507
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-1565
Mailing Address - Country:US
Mailing Address - Phone:559-603-7367
Mailing Address - Fax:559-603-7366
Practice Address - Street 1:45 E RIVER PARK PL W STE 507
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-1565
Practice Address - Country:US
Practice Address - Phone:559-603-7367
Practice Address - Fax:559-603-7366
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-06
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA128029207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine