Provider Demographics
NPI:1104038082
Name:KO, JOHNNY CHU (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:CHU
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 1:61 PEYTON PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-9702
Mailing Address - Country:US
Mailing Address - Phone:901-854-5527
Mailing Address - Fax:901-854-5531
Practice Address - Street 1:61 PEYTON PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-9702
Practice Address - Country:US
Practice Address - Phone:901-854-5527
Practice Address - Fax:901-854-5531
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS 42151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice