Provider Demographics
NPI:1942421912
Name:KOH, KYO JUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:KYO
Middle Name:JUNG
Last Name:KOH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:193 BURROWS LANE
Mailing Address - Street 2:
Mailing Address - City:BLAUVELT
Mailing Address - State:NY
Mailing Address - Zip Code:10913
Mailing Address - Country:US
Mailing Address - Phone:845-613-7797
Mailing Address - Fax:914-948-2301
Practice Address - Street 1:266 E BRYANT AVE.
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605
Practice Address - Country:US
Practice Address - Phone:914-948-2404
Practice Address - Fax:914-948-2301
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY135114207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine