Jae Ko, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019027485 Issued in IL

Practice address

3434 W Peterson Ave
Suite 1D
Chicago, IL 60659-3319

Phone

(872) 208-7573

Fax

(872) 806-0113

NPI assigned

Oct 17, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ko Dental Care P.C.

  • General Practice Dentistry
  • Chicago, IL
  • NPI 1386021954
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1192579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1430524800000",
    "number": "1013106830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2840 W BERWYN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606253402",
            "telephone_number": "646-220-5353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3434 W PETERSON AVE",
            "address_2": "SUITE 1D",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606593319",
            "telephone_number": "872-208-7573",
            "fax_number": "872-806-0113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KO",
        "first_name": "JAE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-10-17",
        "last_updated": "2015-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019027485",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ko Dental Care P.C.
• Benjamin Shay Chee Ko, M.D.
• Bona Ko, M.D.
• Chien I Ko, MD
• Cordelia Ko, PA-C
• Jason Hyunsuk Ko, M.D.
• Jennifer Ko
• Jocelyn S Rancap Ko, APRN
• Kichul Ko
• Mary Patricia Ko, APN NURSE PRACTITION

• General Practice Dentistry in Chicago, IL
• Providers in Chicago, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.