Healthcare Provider Details

I. General information

NPI: 1457269029
Provider Name (Legal Business Name): JAMIE KO, DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
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 TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMIE KO
Title or Position: CEO / PRINCIPAL DENTIST
Credential: DDS
Phone: 279-321-9030