Provider Demographics
NPI:1831124726
Name:KU, YON H (OD)
Entity Type:Individual
Prefix:DR
First Name:YON
Middle Name:H
Last Name:KU
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11955 W ALBANY DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-2482
Mailing Address - Country:US
Mailing Address - Phone:206-437-8151
Mailing Address - Fax:
Practice Address - Street 1:11513 W FAIRVIEW AVE STE 106
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-7887
Practice Address - Country:US
Practice Address - Phone:208-322-8439
Practice Address - Fax:208-322-8433
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-100135152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist