Active NPI
Hyung Kwon Ko, DMD
- Dentist
- Oakland, CA
National Provider Identifier
1013171396
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DS037564
- Practice address
- 225 41St St Apt 613
Oakland, CA 94611-5665 - Phone
- (510) 409-4603
- NPI assigned
- Jul 15, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DS037564 | PA | Primary |
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 61538 | CA |
Addresses
Primary practice location
225 41St St Apt 613
Oakland, CA 94611-5665
Mailing address
225 41St St Apt 613
Oakland, CA 94611-5665
Phone (510) 409-4603
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS037564 | PA | MD | Dentist |
| 61538 | CA | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1216080000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1355097600000",
"number": "1013171396",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "225 41ST ST APT 613",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946115665",
"telephone_number": "510-409-4603"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "225 41ST ST APT 613",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946115665",
"telephone_number": "510-409-4603"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KO",
"first_name": "HYUNG",
"middle_name": "KWON",
"name_prefix": "Mr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-07-15",
"last_updated": "2012-12-10",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "PA",
"license": "DS037564",
"primary": true
},
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "CA",
"license": "61538",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oakland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.