Provider Demographics
NPI:1871604918
Name:YIH-SONGKO, MD, P.C.
Entity type:Organization
Organization Name:YIH-SONGKO, MD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YIH-SONG
Authorized Official - Middle Name:
Authorized Official - Last Name:KO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-458-7220
Mailing Address - Street 1:675 N BROAD STREET EXT
Mailing Address - Street 2:PINE MEDICAL CENTER
Mailing Address - City:GROVE CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16127-4604
Mailing Address - Country:US
Mailing Address - Phone:724-458-7220
Mailing Address - Fax:724-458-1101
Practice Address - Street 1:675 N BROAD STREET EXT
Practice Address - Street 2:PINE MEDICAL CENTER
Practice Address - City:GROVE CITY
Practice Address - State:PA
Practice Address - Zip Code:16127-4604
Practice Address - Country:US
Practice Address - Phone:724-458-7220
Practice Address - Fax:724-458-1101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
119723Medicare PIN