Provider Demographics
NPI:1700982055
Name:RO, YOUNG KYUN (MD)
Entity Type:Individual
Prefix:DR
First Name:YOUNG
Middle Name:KYUN
Last Name:RO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1 ELM ST
Mailing Address - Street 2:PARKWAY PLAZA MEDICAL CENTER
Mailing Address - City:TUCKAHOE
Mailing Address - State:NY
Mailing Address - Zip Code:10707
Mailing Address - Country:US
Mailing Address - Phone:914-337-0606
Mailing Address - Fax:914-337-6780
Practice Address - Street 1:1 ELM ST
Practice Address - Street 2:PARKWAY PLAZA MEDICAL CENTER
Practice Address - City:TUCKAHOE
Practice Address - State:NY
Practice Address - Zip Code:10707
Practice Address - Country:US
Practice Address - Phone:914-337-0606
Practice Address - Fax:914-337-6780
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2008-04-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY172773207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01414942Medicaid
NY0D0715OtherHEALTH NET
NY3719700-001OtherCIGNA
NY4335805OtherAETNA
NY07E191OtherEMPIRE BC / BS
NYWP505OtherOXFORD
NYWP505OtherOXFORD
NY0D0715OtherHEALTH NET