Provider Demographics
NPI:1023108107
Name:KO, AYE K (DDS)
Entity type:Individual
Prefix:DR
First Name:AYE
Middle Name:K
Last Name:KO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:RAYMOND
Other - Middle Name:AK
Other - Last Name:KO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1409 N FRESNO ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-3708
Mailing Address - Country:US
Mailing Address - Phone:559-264-4543
Mailing Address - Fax:559-264-0226
Practice Address - Street 1:1409 N FRESNO ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-3708
Practice Address - Country:US
Practice Address - Phone:559-264-4543
Practice Address - Fax:559-264-0226
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA371241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG98007-01OtherHEALTHY FAMILIES
1310258OtherUNITED CONCORDIA
CAG91796-01OtherDENTI-CAL