Organization
KO DENTAL CARE P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAE KO DDS (PRESIDENT)
(646) 220-5353
Entity
Organization
Contact information
Practice address
3434 W PETERSON AVE, SUITE 1D, CHICAGO, IL 60659-3319
(872) 208-7573
(872) 806-0113
Mailing address
2840 W BERWYN AVE, CHICAGO, IL 60625-3402
(872) 208-7573
(872) 806-0113
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019027485
IL
Other
Enumeration date
05/02/2015
Last updated
05/02/2015
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