Individual
DR. KYONG YOL KO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
545 S. COUNTY LINE DR., SPACE A, CHAPARRAL, NM 88081-7809
(505) 824-5007
(505) 824-0322
Mailing address
101 GREEN PASTURE CT, ANTHONY, NM 88021
(505) 824-5007
(505) 825-0322
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2003-0543
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40725391
—
NM
Enumeration date
06/20/2005
Last updated
12/19/2013
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