Provider Demographics
NPI:1457533648
Name:YUNG K KHO MD PC
Entity Type:Organization
Organization Name:YUNG K KHO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YUNG
Authorized Official - Middle Name:K
Authorized Official - Last Name:KHO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-474-5071
Mailing Address - Street 1:1601 NE 6TH STREET
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-1494
Mailing Address - Country:US
Mailing Address - Phone:541-474-5071
Mailing Address - Fax:541-476-0866
Practice Address - Street 1:1601 NE 6TH STREET
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1494
Practice Address - Country:US
Practice Address - Phone:541-474-5071
Practice Address - Fax:541-476-0866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD129122084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR229260Medicaid
R110151Medicare PIN
A26537Medicare UPIN