Ronald Matthew Ko, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

DE60810468 Issued in WA

Practice address

10211 144TH St E
Puyallup, WA 98374-4955

Phone

(253) 848-7281

NPI assigned

Jul 13, 2016

Last updated

Sep 18, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Optim Dental LLC

  • Dentist
  • Springfield, IL
  • NPI 1265820906
  NPD (past)

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

{
    "created_epoch": "1468368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631923200000",
    "number": "1942652037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10211 144TH ST E",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983744955",
            "telephone_number": "206-676-2438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10211 144TH ST E",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983744955",
            "telephone_number": "253-848-7281"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KO",
        "first_name": "RONALD",
        "middle_name": "MATTHEW",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-07-13",
        "last_updated": "2021-09-18",
        "certification_date": "2021-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019.030854",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE60810468",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Annette Knowles
• Richard Thomas Knowlton, NP
• Tara Knutsen
• Kimberly Dawn Knutson, LMP
• Melanie Chastine Knutson
• Heidi Koch, COTA/L
• Brenda F Kodama, MD
• Laura Koehler-Davidson, LMT
• Isabell C Kohn
• Kendra Jean- Kolasinski

• Dentist in Puyallup, WA
• Providers in Puyallup, WA by specialty
• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2021; 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.