Provider Demographics
NPI:1265547277
Name:KO, EDALYN MENDOZA (DPM)
Entity type:Individual
Prefix:
First Name:EDALYN
Middle Name:MENDOZA
Last Name:KO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1400 VALLEY RIVER DR STE 210
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6759
Mailing Address - Country:US
Mailing Address - Phone:541-600-4630
Mailing Address - Fax:877-370-7523
Practice Address - Street 1:1400 VALLEY RIVER DR STE 210
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6759
Practice Address - Country:US
Practice Address - Phone:541-600-4630
Practice Address - Fax:877-370-7523
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00360213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery