Provider Demographics
NPI:1063630358
Name:SO, MAN KI (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAN KI
Middle Name:
Last Name:SO
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 1:250 E 40TH ST
Mailing Address - Street 2:APT 38-B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-1721
Mailing Address - Country:US
Mailing Address - Phone:917-442-2188
Mailing Address - Fax:
Practice Address - Street 1:5412 KINGS PLZ
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5217
Practice Address - Country:US
Practice Address - Phone:917-442-2188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0504211223X0400X
NJ22DI023391001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics