Individual
DR. HAENG KO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1440 RUSSELL RD, PAOLI, PA 19301-1236
(610) 644-6464
Mailing address
1440 RUSSELL RD, PAOLI, PA 19301-1236
(610) 644-6464
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
25MA02965000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0080346000
IBC
PA
01
—
110857C2B
MEDICARE BILLING NUMBER
NJ
01
—
125884000
KEYSTONE
PA
01
—
4090818
AETNA
PA
Enumeration date
08/31/2006
Last updated
10/23/2007
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