Provider Demographics
NPI:1053464586
Name:KO, JOE D I (DDS)
Entity type:Individual
Prefix:DR
First Name:JOE
Middle Name:D
Last Name:KO
Suffix:I
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JOE
Other - Middle Name:DAI-YOUNG
Other - Last Name:KO
Other - Suffix:I
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:902 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-5341
Mailing Address - Country:US
Mailing Address - Phone:714-835-5921
Mailing Address - Fax:
Practice Address - Street 1:902 E.1ST ST.
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-5341
Practice Address - Country:US
Practice Address - Phone:714-835-5921
Practice Address - Fax:714-835-4734
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35282122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist