MEDICARE: DAVID J. JO DDS MS INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	30682	CA

General Provider Information

NPI Number	:	1609919786
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID J. JO DDS MS INC.

Provider Business Mailing Address
First Line	:	3120 S HACIENDA BLVD
Second Line	:	SUITE 205
City	:	HACIENDA HEIGHTS
State	:	CA
Zip	:	91745-6305
Country	:	US
Telephone Number	:	626-330-3116
Fax Number	:

Provider Business Practice Location Address
First Line	:	3120 S HACIENDA BLVD
Second Line	:	SUITE 205
City	:	HACIENDA HEIGHTS
State	:	CA
Zip	:	91745-6305
Country	:	US
Telephone Number	:	626-330-3116
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID JAEKWAN JO
Credential	:	D.D.S., M.S.
Telephone Number	:	626-330-3116

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	08/22/2020

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