Provider Demographics
NPI:1649219650
Name:KO, RICHARD JUNEYOUNG (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:JUNEYOUNG
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 1:4101 HUNT RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22032-1461
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14820 PHYSICIANS LN
Practice Address - Street 2:242
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3945
Practice Address - Country:US
Practice Address - Phone:301-838-9606
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD44813207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
80625675OtherTRICARE
80625675OtherTRICARE
F60310Medicare UPIN
G01485F29Medicare ID - Type UnspecifiedG01485