Healthcare Provider Details

I. General information

NPI: 1275298937
Provider Name (Legal Business Name): MEI-HSUAN KO DDS., MS., PLLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2021
Last Update Date: 11/07/2021
Certification Date: 11/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12826 SE 40TH LN STE 102
BELLEVUE WA
98006-5266
US

IV. Provider business mailing address

12826 SE 40TH LN STE 102
BELLEVUE WA
98006-5266
US

V. Phone/Fax

Practice location:
  • Phone: 425-877-1423
  • Fax:
Mailing address:
  • Phone: 425-877-1423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHELLE MEI-HSUAN KO
Title or Position: PRESIDENT
Credential: DDS
Phone: 206-474-7394