Healthcare Provider Details

I. General information

NPI: 1477345940
Provider Name (Legal Business Name): YEOUN KO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8717 S TACOMA WAY
TACOMA WA
98499-4544
US

IV. Provider business mailing address

443 RAMSAY WAY APT 235
KENT WA
98032-5014
US

V. Phone/Fax

Practice location:
  • Phone: 253-588-9951
  • Fax:
Mailing address:
  • Phone: 206-678-9707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: