# JACK KOU

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1295094563
- **Gender:** Man
- **Credential:** D.D.S.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 2901601605 | MI | Yes |

## Other

- **Enumeration date:** 05/08/2012
- **Last updated:** 03/06/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 019029583 | — | IL |