Provider Demographics
NPI:1033402508
Name:KO, MOON-HEE
Entity Type:Individual
Prefix:
First Name:MOON-HEE
Middle Name:
Last Name:KO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 S DE LACEY AVE UNIT 2134
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-4502
Mailing Address - Country:US
Mailing Address - Phone:213-700-9020
Mailing Address - Fax:
Practice Address - Street 1:257 S DE LACEY AVE UNIT 2134
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-4502
Practice Address - Country:US
Practice Address - Phone:213-700-9020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49915122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist