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General NPI Number Information
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NPI Number | 1841578762
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Entity Type | Individual
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Provider Name | ALEXANDER KO DMD, MSD
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Gender | Male
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Dates
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Enumeration Date | 07/26/2011
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Last Update Date | 08/01/2024
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Provider Practice Location Address
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Address Line | 12826 SE 40TH LN STE 100
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City | BELLEVUE
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State | WA
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Zip | 98006-5266
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Country | US
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Telephone | 425-877-1423
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Fax |
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Provider Business Mailing Address
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Address Line | 12826 SE 40TH LN STE 100
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City | BELLEVUE
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State | WA
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Zip | 98006-5266
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Country | US
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Telephone | 425-877-1423
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DE60743293
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License Number State | WA
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