Provider Demographics
NPI:1790718641
Name:KO, MIN-HSIUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:MIN-HSIUNG
Middle Name:
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:PO BOX 465
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-0465
Mailing Address - Country:US
Mailing Address - Phone:215-245-5120
Mailing Address - Fax:215-245-5121
Practice Address - Street 1:2075 BYBERRY RD
Practice Address - Street 2:SUITE 107
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-3841
Practice Address - Country:US
Practice Address - Phone:215-245-5120
Practice Address - Fax:215-245-5121
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034061-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA109823OtherIBC
PA0061739001OtherKEYSTONE HEALTH PLAN EAS
PA0698653Medicaid
PA0061739001OtherKEYSTONE HEALTH PLAN EAS
PAC-30392Medicare UPIN