Provider Demographics
NPI:1720311178
Name:KO, SUNGHWAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:SUNGHWAN
Middle Name:
Last Name:KO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7839 EASTPOINT MALL
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-2116
Mailing Address - Country:US
Mailing Address - Phone:443-503-3139
Mailing Address - Fax:
Practice Address - Street 1:7839 EASTPOINT MALL
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-2116
Practice Address - Country:US
Practice Address - Phone:443-503-3139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1855281122300000X
RI030541223G0001X
MD165661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist