Provider Demographics
NPI:1598998817
Name:SUE EUNSOO KO, DDS, INC.
Entity Type:Organization
Organization Name:SUE EUNSOO KO, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUE
Authorized Official - Middle Name:EUNSOO
Authorized Official - Last Name:KO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-619-1497
Mailing Address - Street 1:10715 S PRAIRIE AVE
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90303-2113
Mailing Address - Country:US
Mailing Address - Phone:310-419-6463
Mailing Address - Fax:310-419-4678
Practice Address - Street 1:10715 S PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90303-2113
Practice Address - Country:US
Practice Address - Phone:310-419-6463
Practice Address - Fax:310-419-4678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-03
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA530791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty