Provider Demographics
NPI:1760653992
Name:GEORGE M. KO, D.D.S., INC.
Entity Type:Organization
Organization Name:GEORGE M. KO, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:MING HUI
Authorized Official - Last Name:KO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-284-8022
Mailing Address - Street 1:531 W LAS TUNAS DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-1166
Mailing Address - Country:US
Mailing Address - Phone:626-284-8022
Mailing Address - Fax:
Practice Address - Street 1:531 W LAS TUNAS DR
Practice Address - Street 2:SUITE C
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1166
Practice Address - Country:US
Practice Address - Phone:626-284-8022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-15
Last Update Date:2008-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38071122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty