Provider Demographics
NPI:1316914997
Name:KOH, ANDREW YOUNG (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:YOUNG
Last Name:KOH
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:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:214-456-2382
Mailing Address - Fax:214-456-6133
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-7208
Practice Address - Country:US
Practice Address - Phone:214-456-2382
Practice Address - Fax:214-456-6133
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1590212080P0207X, 2080P0208X
TXN31192080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
7627170OtherCIGNA
MA3195571Medicaid
J21026OtherMA BCBS
159021OtherTUFTS
AA11740OtherHPHC DFCI ONLY
A2981OtherMEDICARE
A2981OtherMEDICARE