Provider Demographics
NPI:1104696970
Name:KO, YI-CHUN (DTCM, LAC)
Entity type:Individual
Prefix:DR
First Name:YI-CHUN
Middle Name:
Last Name:KO
Suffix:
Gender:F
Credentials:DTCM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W HARBOR DR UNIT 1706
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-7757
Mailing Address - Country:US
Mailing Address - Phone:185-826-0893
Mailing Address - Fax:
Practice Address - Street 1:1011 CAMINO DEL RIO S STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3532
Practice Address - Country:US
Practice Address - Phone:619-915-6007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC19245171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist