Provider Demographics
NPI:1093877672
Name:PHILIP D. JO, D.D.S. INC.
Entity Type:Organization
Organization Name:PHILIP D. JO, D.D.S. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:DAE-HYUN
Authorized Official - Last Name:JO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-435-9471
Mailing Address - Street 1:2 OSBORN ST
Mailing Address - Street 2:STE 130
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-8656
Mailing Address - Country:US
Mailing Address - Phone:949-748-3636
Mailing Address - Fax:949-748-3638
Practice Address - Street 1:2 OSBORN ST
Practice Address - Street 2:STE 130
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-8656
Practice Address - Country:US
Practice Address - Phone:949-748-3636
Practice Address - Fax:949-748-3638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48472261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental