Provider Demographics
NPI:1043334709
Name:JO, KYONG H (PSY D)
Entity type:Individual
Prefix:DR
First Name:KYONG
Middle Name:H
Last Name:JO
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:KYONG
Other - Middle Name:H
Other - Last Name:JO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSY D
Mailing Address - Street 1:1847 SINALOA AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-1559
Mailing Address - Country:US
Mailing Address - Phone:626-720-7878
Mailing Address - Fax:
Practice Address - Street 1:1847 SINALOA AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-1559
Practice Address - Country:US
Practice Address - Phone:626-720-7878
Practice Address - Fax:626-316-6780
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY32459103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical