Provider Demographics
NPI:1720041106
Name:YU SONG KAO MDPC
Entity Type:Organization
Organization Name:YU SONG KAO MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YU SONG
Authorized Official - Middle Name:
Authorized Official - Last Name:KAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-829-6644
Mailing Address - Street 1:166 HANOVER STREET
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-3544
Mailing Address - Country:US
Mailing Address - Phone:570-829-6644
Mailing Address - Fax:570-829-6446
Practice Address - Street 1:166 HANOVER STREET
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-3544
Practice Address - Country:US
Practice Address - Phone:570-829-6644
Practice Address - Fax:570-829-6446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-07
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD017676E2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006019400002Medicaid
C31403Medicare UPIN
PA0006019400002Medicaid