Provider Demographics
NPI:1174989875
Name:KOH-GALE, SIN WEE (AGPCNP)
Entity type:Individual
Prefix:MR
First Name:SIN WEE
Middle Name:
Last Name:KOH-GALE
Suffix:
Gender:M
Credentials:AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35400 BOB HOPE DR STE 210
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-1774
Mailing Address - Country:US
Mailing Address - Phone:760-202-0686
Mailing Address - Fax:760-770-4563
Practice Address - Street 1:35400 BOB HOPE DR STE 210
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-1774
Practice Address - Country:US
Practice Address - Phone:760-202-0686
Practice Address - Fax:760-770-4563
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-11
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95003233363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health