Individual
GANG I KO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
4141 SPRUCE ST APT G1, PHILADELPHIA, PA 19104-4071
(240) 888-0620
Mailing address
4141 SPRUCE ST APT G1, PHILADELPHIA, PA 19104-4071
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS040601
PA
Other
Enumeration date
09/29/2015
Last updated
09/29/2015
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