Provider Demographics
NPI:1356792758
Name:KO, JE DEUK (MD PHD)
Entity type:Individual
Prefix:DR
First Name:JE
Middle Name:DEUK
Last Name:KO
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9736 YOAKUM DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-1436
Mailing Address - Country:US
Mailing Address - Phone:310-922-0584
Mailing Address - Fax:
Practice Address - Street 1:10921 WILSHIRE BLVD STE 409B
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-4001
Practice Address - Country:US
Practice Address - Phone:310-922-0584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2787392084P0804X, 2084P0800X
CAA1790402084P0804X
MO2016021108390200000X
CA1790402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program