Provider Demographics
NPI:1962681361
Name:KOH, JOYCE JAYOUNG (DDS)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:JAYOUNG
Last Name:KOH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:45 S PARK BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-6280
Mailing Address - Country:US
Mailing Address - Phone:630-858-8755
Mailing Address - Fax:630-858-6204
Practice Address - Street 1:45 S PARK BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-6280
Practice Address - Country:US
Practice Address - Phone:630-858-8755
Practice Address - Fax:630-858-6204
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL0190269661223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry