Provider Demographics
NPI:1609056027
Name:KO, JING-YANG ELTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:JING-YANG
Middle Name:ELTON
Last Name:KO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JING YANG
Other - Middle Name:
Other - Last Name:KO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:271 ROUTE 46 W STE E101
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07004-2488
Mailing Address - Country:US
Mailing Address - Phone:973-808-9820
Mailing Address - Fax:973-808-9730
Practice Address - Street 1:271 ROUTE 46 W STE E101
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004-2488
Practice Address - Country:US
Practice Address - Phone:973-808-9820
Practice Address - Fax:973-808-9730
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ157271223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics