Provider Demographics
NPI:1053522938
Name:KO, SIU-KEUNG ANDREW (DMD)
Entity type:Individual
Prefix:DR
First Name:SIU-KEUNG
Middle Name:ANDREW
Last Name:KO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 SW 117TH AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-4809
Mailing Address - Country:US
Mailing Address - Phone:305-270-8883
Mailing Address - Fax:305-270-8884
Practice Address - Street 1:8000 SW 117TH AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-4809
Practice Address - Country:US
Practice Address - Phone:305-270-8883
Practice Address - Fax:305-270-8884
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15996122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist