Provider Demographics
NPI:1851425771
Name:KY L. DO, DDS, DENTAL CORP.
Entity type:Organization
Organization Name:KY L. DO, DDS, DENTAL CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:VIKKY
Authorized Official - Middle Name:
Authorized Official - Last Name:FUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-642-0288
Mailing Address - Street 1:333 S GARFIELD AVE STE B
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-3895
Mailing Address - Country:US
Mailing Address - Phone:626-642-0288
Mailing Address - Fax:626-642-0297
Practice Address - Street 1:333 S GARFIELD AVE STE B
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-3895
Practice Address - Country:US
Practice Address - Phone:626-642-0288
Practice Address - Fax:626-642-0297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA413991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA41399OtherDENTISTRY