Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DS038375 | PA |
Y | 1223P0700X | Prosthodontist | DS038375 | PA |
NPI | 1033425566 |
---|---|
Provider Name | Dr. Vivian Yu-Wei Ko |
First Address | Ft Campbell, KY 42223-5660 |
Second Address | Ft Campbell, KY 42223-5660 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2010 |
Last Update Date | 29/07/2015 |