Individual
JENNIFER KO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
19925 22ND AVE, WHITESTONE, NY 11357-4121
(347) 255-5388
Mailing address
19925 22ND AVE, WHITESTONE, NY 11357-4121
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
058643
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/15/2015
Last updated
08/03/2021
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