Provider Demographics
NPI:1992557524
Name:KEVIN KO, A PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:KEVIN KO, A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:925-934-0192
Mailing Address - Street 1:3190 OLD TUNNEL RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-4185
Mailing Address - Country:US
Mailing Address - Phone:925-934-0192
Mailing Address - Fax:925-448-3833
Practice Address - Street 1:3190 OLD TUNNEL RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-4185
Practice Address - Country:US
Practice Address - Phone:925-934-0192
Practice Address - Fax:925-448-3833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-05
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental