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General NPI Number Information
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NPI Number | 1518145366
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Entity Type | Organization
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Legal Business Name | JESSE KO, MD, PLLC
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Dates
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Enumeration Date | 02/04/2008
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Last Update Date | 08/01/2023
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Provider Practice Location Address
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Address Line | 20945 45TH RD FL 1
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City | BAYSIDE
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State | NY
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Zip | 11361-3233
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Country | US
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Telephone | 718-423-7200
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Fax | 718-224-8727
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Provider Business Mailing Address
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Address Line | 20945 45TH RD FL 1
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City | BAYSIDE
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State | NY
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Zip | 11361-3233
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Country | US
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Telephone | 718-423-7200
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Fax | 718-224-8727
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Authorized Official
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Title or Position | OWNER
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Name | DR. JESSE KO
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Credential | M.D.
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Telephone | 718-423-7200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 213571
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License Number State | NY
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