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General NPI Number Information
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NPI Number | 1104970896
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Entity Type | Individual
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Provider Name | JUDITH Y KO D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1600 E FLORIDA AVE SUITE 318
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City | HEMET
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State | CA
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Zip | 92544-8643
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Country | US
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Telephone | 951-658-2338
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Fax | 951-658-2058
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Provider Business Mailing Address
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Address Line | 1600 E FLORIDA AVE STE 318
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City | HEMET
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State | CA
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Zip | 92544-8639
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Country | US
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Telephone | 951-658-2338
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Fax | 951-658-2058
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 44911
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License Number State | CA
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