Provider Demographics
NPI:1598488967
Name:Y. JASMINE KO DDS PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:Y. JASMINE KO DDS PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YI
Authorized Official - Middle Name:J
Authorized Official - Last Name:KO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-290-4442
Mailing Address - Street 1:710 WHITEWING LN
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-1849
Mailing Address - Country:US
Mailing Address - Phone:626-290-4442
Mailing Address - Fax:
Practice Address - Street 1:1850 S AZUSA AVE STE 108
Practice Address - Street 2:
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-6827
Practice Address - Country:US
Practice Address - Phone:626-912-9394
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-21
Last Update Date:2022-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty