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NPI Code Detail

MEDICARE: WOO JONG KO DDS

MEDICARE: WOO JONG 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
11223G0001XGeneral Practice DentistryDD5099NM
21223G0001XGeneral Practice Dentistry54058CA

General Provider Information

NPI Number : 1669452108
Entity Type Code : Individual
Provider Name (Legal Business Name) : WOO JONG KO DDS
Provider Business Mailing Address
First Line : PO BOX 370
Second Line :
City : HATCH
State : NM
Zip : 87937-0370
Country : US
Telephone Number : 575-267-3280
Fax Number : 575-267-1747
Provider Business Practice Location Address
First Line : 1998 N MOTEL BLVD
Second Line :
City : LAS CRUCES
State : NM
Zip : 88007-4100
Country : US
Telephone Number : 575-541-5941
Fax Number : 575-541-5048
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2006
Last Update Date : 07/19/2019

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Directions to “ WOO JONG KO DDS” Practice Location

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