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General NPI Number Information
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NPI Number | 1194042309
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Entity Type | Individual
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Provider Name | EUGENE MYUNG KO DDS
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Gender | Male
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Dates
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Enumeration Date | 04/27/2010
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 240 S 40TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19104-6030
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Country | US
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Telephone | 215-537-8177
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Fax |
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Provider Business Mailing Address
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Address Line | 240 S 40TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19104-6030
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Country | US
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Telephone | 215-573-8177
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901021194
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1223P0106X
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Taxonomy Name | Oral and Maxillofacial Pathology Dentistry
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License Number | 056653
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 1223P0106X
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Taxonomy Name | Oral and Maxillofacial Pathology Dentistry
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License Number | 2901021194
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 2901021194
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License Number State | MI
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