Provider Demographics
NPI:1982602181
Name:KO, YIH-SHYONG (MD)
Entity Type:Individual
Prefix:
First Name:YIH-SHYONG
Middle Name:
Last Name:KO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:YIH
Other - Middle Name:SHYONG
Other - Last Name:KO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 650782
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0782
Mailing Address - Country:US
Mailing Address - Phone:302-733-0806
Mailing Address - Fax:302-733-0854
Practice Address - Street 1:211 N 12TH ST
Practice Address - Street 2:
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-1138
Practice Address - Country:US
Practice Address - Phone:215-442-5085
Practice Address - Fax:877-329-2370
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036519L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0004958310036Medicaid
PAP00692009OtherRAILROAD MEDICARE
PA000667281Medicaid
PA000667281Medicaid
PA076216Medicare PIN