Provider Demographics
NPI:1689744328
Name:KO, ANDREW PIN-WEI (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:PIN-WEI
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 1:11100 WARNER AVE STE 262
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-7512
Mailing Address - Country:US
Mailing Address - Phone:714-979-7788
Mailing Address - Fax:714-979-7799
Practice Address - Street 1:11100 WARNER AVE STE 262
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-7512
Practice Address - Country:US
Practice Address - Phone:714-979-7788
Practice Address - Fax:714-979-7799
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76901208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA76901Medicaid