Provider Demographics
NPI:1669536801
Name:KO-YOUNG, YIN SHEL
Entity type:Individual
Prefix:
First Name:YIN
Middle Name:SHEL
Last Name:KO-YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:YIN
Other - Middle Name:SHEL
Other - Last Name:KO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:310 8TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-6526
Mailing Address - Country:US
Mailing Address - Phone:925-681-9627
Mailing Address - Fax:
Practice Address - Street 1:310 8TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-6526
Practice Address - Country:US
Practice Address - Phone:510-869-6028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3769OtherCA. MENTAL HEALTH #