Provider Demographics
NPI:1104970896
Name:KO, JUDITH Y (DDS)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:Y
Last Name:KO
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 1:1600 E FLORIDA AVE STE 318
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92544-8639
Mailing Address - Country:US
Mailing Address - Phone:951-658-2338
Mailing Address - Fax:951-658-2058
Practice Address - Street 1:1600 E FLORIDA AVE
Practice Address - Street 2:SUITE 318
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544-8643
Practice Address - Country:US
Practice Address - Phone:951-658-2338
Practice Address - Fax:951-658-2058
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA449111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice