MEDICARE: JAE KO DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	019027485	IL

General Provider Information

NPI Number	:	1013106830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAE KO DDS

Provider Business Mailing Address
First Line	:	2840 W BERWYN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3402
Country	:	US
Telephone Number	:	646-220-5353
Fax Number	:

Provider Business Practice Location Address
First Line	:	3434 W PETERSON AVE
Second Line	:	SUITE 1D
City	:	CHICAGO
State	:	IL
Zip	:	60659-3319
Country	:	US
Telephone Number	:	872-208-7573
Fax Number	:	872-806-0113

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2007
Last Update Date	:	05/02/2015

Similar Medicare Providers

1114909363 — ANNIE JOHN, M.D.S.C.
Practice Location Address:

3434 W PETERSON AVE , 1A
CHICAGO, IL
60659-3319

Practice Phone: 773-583-5803
Practice Fax:

1225013998 — ANNIE JOHN M.D.
Practice Location Address:

3434 W PETERSON AVE , 1A
CHICAGO, IL
60659-3319

Practice Phone: 773-583-5803
Practice Fax: 773-248-2348

1295760783 — DR. JALAJAKSHI POTLURI MD, FACP
Practice Location Address:

3434 W PETERSON AVE
CHICAGO, IL
60659-3319

Practice Phone: 773-279-1800
Practice Fax: 773-463-3664

1922180330 — KEITH K NAM MD
Practice Location Address:

3434 W PETERSON AVE , SUITE 202
CHICAGO, IL
60659-3319

Practice Phone: 773-267-0781
Practice Fax: 773-267-0968

1457526063 — KEY I. NAM, MD, SC.
Practice Location Address:

3434 W PETERSON AVE , SUITE 202
CHICAGO, IL
60659-3319

Practice Phone: 773-267-0781
Practice Fax:

1386021954 — KO DENTAL CARE P.C.
Practice Location Address:

3434 W PETERSON AVE , SUITE 1D
CHICAGO, IL
60659-3319

Practice Phone: 872-208-7573
Practice Fax: 872-806-0113

Directions to “ JAE KO DDS” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.