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General NPI Number Information
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NPI Number | 1336601822
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Entity Type | Individual
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Provider Name | DAYOUNG KO MD
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Gender | Female
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Dates
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Enumeration Date | 04/03/2019
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Last Update Date | 12/19/2023
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Provider Practice Location Address
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Address Line | 46325 W 12 MILE RD STE 370
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City | NOVI
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State | MI
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Zip | 48377-2464
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Country | US
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Telephone | 248-482-2107
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Fax |
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Provider Business Mailing Address
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Address Line | 43900 GARFIELD RD STE 100
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-1137
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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 |
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 4301509209
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License Number State | MI
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