Provider Demographics
NPI:1003973934
Name:KO, STEVEN SUKKYU (DDS)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:SUKKYU
Last Name:KO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7222 VAN NUYS
Mailing Address - Street 2:BL B
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405
Mailing Address - Country:US
Mailing Address - Phone:818-988-6393
Mailing Address - Fax:818-988-6395
Practice Address - Street 1:7222 VAN NUYS
Practice Address - Street 2:BL B
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405
Practice Address - Country:US
Practice Address - Phone:818-988-6393
Practice Address - Fax:818-988-6395
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26270122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB2627001Medicaid