Provider Demographics
NPI:1275867855
Name:KO, MICHELLE MEI-HSUAN (DDS, MS)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MEI-HSUAN
Last Name:KO
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:MEI-HSUAN
Other - Middle Name:
Other - Last Name:KO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS MS
Mailing Address - Street 1:12826 SE 40TH LN STE 102
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-5266
Mailing Address - Country:US
Mailing Address - Phone:206-474-7394
Mailing Address - Fax:
Practice Address - Street 1:12826 SE 40TH LN STE 102
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-5266
Practice Address - Country:US
Practice Address - Phone:425-877-1423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2021-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL10735122300000X
WADE606311231223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist