Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 2901021194 | MI |
N | 1223P0106X | Oral and Maxillofacial Pathology | 056653 | NY |
N | 1223P0106X | Oral and Maxillofacial Pathology | 2901021194 | MI |
NPI | 1194042309 |
---|---|
Provider Name | Dr. Eugene Myung Ko |
First Address | Toledo, OH 43614-1509 |
Second Address | Ann Arbor, MI 48109-1078 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2010 |
Last Update Date | 17/04/2017 |