Provider Demographics
NPI:1619382603
Name:NG, KOK-TOW (DDS)
Entity Type:Individual
Prefix:DR
First Name:KOK-TOW
Middle Name:
Last Name:NG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4131 UNIVERSITY BLVD S STE 5
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4346
Mailing Address - Country:US
Mailing Address - Phone:904-731-0521
Mailing Address - Fax:904-731-0518
Practice Address - Street 1:4131 UNIVERSITY BLVD S STE 5
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4346
Practice Address - Country:US
Practice Address - Phone:904-731-0521
Practice Address - Fax:904-731-0518
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-27
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL121851223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics