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General NPI Number Information
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NPI Number | 1134819717
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Entity Type | Organization
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Legal Business Name | KO AND NAM DDS A PROFESSIONAL DENTAL CORPORATION
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Dates
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Enumeration Date | 05/09/2023
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Last Update Date | 05/09/2023
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Provider Practice Location Address
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Address Line | 1317 W FOOTHILL BLVD STE 138
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City | UPLAND
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State | CA
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Zip | 91786-3693
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Country | US
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Telephone | 909-303-3449
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Fax |
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Provider Business Mailing Address
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Address Line | 3553 GRAYBURN RD
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City | PASADENA
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State | CA
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Zip | 91107-4628
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DDS
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Name | MOON-HEE KO
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Credential |
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Telephone | 213-700-9020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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