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General NPI Number Information
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NPI Number | 1376764720
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Entity Type | Individual
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Provider Name | JOHN KO DDS
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Gender | Male
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5720 STONERIDGE MALL RD STE 200
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City | PLEASANTON
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State | CA
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Zip | 94588-2878
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Country | US
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Telephone | 925-847-8790
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Fax |
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Provider Business Mailing Address
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Address Line | 5720 STONERIDGE MALL RD STE 200
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City | PLEASANTON
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State | CA
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Zip | 94588-2878
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Country | US
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Telephone | 925-847-8790
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 43804
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License Number State | CA
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