Jae Ko, DDS
Dentist, General Practice in Chicago, IL. Individual provider (NPI-1).
NPI number1013106830
StatusActive
Last updated in NPPESMay 2, 2015
Details
- NPI
- 1013106830
- Entity type
- Individual (NPI-1)
- Name
- Jae Ko
- Credential
- DDS
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Oct 17, 2007
- Last updated
- May 2, 2015
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | 019027485 | IL | Yes |
Practice location
3434 W Peterson AveSuite 1d
Chicago, IL 60659-3319
Phone 872-208-7573 · Fax 872-806-0113
Mailing address
2840 W Berwyn AveChicago, IL 60625-3402
Phone 646-220-5353
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