Provider Demographics
NPI:1932143963
Name:KO, DAVID Y (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:Y
Last Name:KO
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 1:3240 LOMBARDY RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-5533
Mailing Address - Country:US
Mailing Address - Phone:323-697-9802
Mailing Address - Fax:
Practice Address - Street 1:11201 BENTON ST # 2A-205
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92357-5310
Practice Address - Country:US
Practice Address - Phone:909-825-7084
Practice Address - Fax:909-777-3814
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG818722084E0001X, 2084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No2084E0001XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyEpilepsy
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G818720Medicaid
CAG16278Medicare UPIN
CA00G818720Medicaid