Healthcare Provider Details

I. General information

NPI: 1538052550
Provider Name (Legal Business Name): JAMIE KO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3319 J ST
SACRAMENTO CA
95816-4502
US

IV. Provider business mailing address

1550 BROADSTONE PKWY APT 2322
FOLSOM CA
95630-6699
US

V. Phone/Fax

Practice location:
  • Phone: 279-321-9030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number111203
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number111203
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: