MEDICARE: GEORGE M. KO, D.D.S., INC.

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	122300000X	Dentist	38071	CA

General Provider Information

NPI Number	:	1760653992
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGE M. KO, D.D.S., INC.

Provider Business Mailing Address
First Line	:	531 W LAS TUNAS DR
Second Line	:	SUITE C
City	:	SAN GABRIEL
State	:	CA
Zip	:	91776-1166
Country	:	US
Telephone Number	:	626-284-8022
Fax Number	:

Provider Business Practice Location Address
First Line	:	531 W LAS TUNAS DR
Second Line	:	SUITE C
City	:	SAN GABRIEL
State	:	CA
Zip	:	91776-1166
Country	:	US
Telephone Number	:	626-284-8022
Fax Number	:

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	DR. GEORGE MING HUI KO
Credential	:	D.D.S.
Telephone Number	:	626-284-8022

Provider Enumeration Date	:	03/15/2008
Last Update Date	:	03/15/2008

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