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General NPI Number Information
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NPI Number | 1598998817
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Entity Type | Organization
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Legal Business Name | SUE EUNSOO KO, DDS, INC.
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Dates
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Enumeration Date | 09/03/2009
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Last Update Date | 09/03/2009
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Provider Practice Location Address
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Address Line | 10715 S PRAIRIE AVE
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City | INGLEWOOD
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State | CA
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Zip | 90303-2113
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Country | US
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Telephone | 310-419-6463
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Fax | 310-419-4678
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Provider Business Mailing Address
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Address Line | 10715 S PRAIRIE AVE
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City | INGLEWOOD
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State | CA
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Zip | 90303-2113
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Country | US
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Telephone | 310-419-6463
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Fax | 310-419-4678
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Authorized Official
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Title or Position | DENTIST
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Name | DR. SUE EUNSOO KO
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Credential | DDS
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Telephone | 310-619-1497
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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 | 53079
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License Number State | CA
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