Provider Demographics
NPI:1033425566
Name:KO, VIVIAN YU-WEI (DDS)
Entity Type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:YU-WEI
Last Name:KO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2441 21ST STREET
Mailing Address - Street 2:USA DENTAC
Mailing Address - City:FT CAMPBELL
Mailing Address - State:KY
Mailing Address - Zip Code:42223-5660
Mailing Address - Country:US
Mailing Address - Phone:270-798-8614
Mailing Address - Fax:270-798-8633
Practice Address - Street 1:2441 21ST STREET
Practice Address - Street 2:USA DENTAC
Practice Address - City:FT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223-5660
Practice Address - Country:US
Practice Address - Phone:270-798-8614
Practice Address - Fax:270-798-8633
Is Sole Proprietor?:No
Enumeration Date:2010-08-21
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS038375122300000X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist