Provider Demographics
NPI:1447329768
Name:KO, YOUNG H (MD)
Entity type:Individual
Prefix:
First Name:YOUNG
Middle Name:H
Last Name:KO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:568 RUIN CREEK RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-2880
Mailing Address - Country:US
Mailing Address - Phone:252-436-1380
Mailing Address - Fax:252-436-1581
Practice Address - Street 1:568 RUIN CREEK RD
Practice Address - Street 2:SUITE 105
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-2880
Practice Address - Country:US
Practice Address - Phone:252-436-1380
Practice Address - Fax:252-436-1581
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC23393207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891095WMedicaid
NC202145DMedicare ID - Type Unspecified
NCC85723Medicare UPIN