Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 26270 | CA |
NPI | 1003973934 |
---|---|
Provider Name | Steven Sukkyu Ko |
First Address | Van Nuys, CA 91405 |
Second Address | Van Nuys, CA 91405 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B2627001 | (05) | CA |