Provider Demographics
NPI:1902261746
Name:KO, YI JASMINE (DDS)
Entity Type:Individual
Prefix:
First Name:YI
Middle Name:JASMINE
Last Name:KO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:YI
Other - Middle Name:
Other - Last Name:KO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1850 S AZUSA AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-6827
Mailing Address - Country:US
Mailing Address - Phone:626-290-4442
Mailing Address - Fax:
Practice Address - Street 1:1850 S AZUSA AVE STE 108
Practice Address - Street 2:
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-6827
Practice Address - Country:US
Practice Address - Phone:626-912-9394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-21
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65181122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist