JAE M KO - Dentist License in Illinois | # 31*****83

JAE M KO

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****83

License Status

NOT RENEWED

Business

N

First Name

JAE

Middle

M

Last Name

KO

Business Name

JAE M KO

Original Issue Date

10/05/2007

Effective Date

10/05/2007

Expiration Date

09/30/2009

City

WAUKEGAN

State

IL

Zip

60085

County

LAKE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

N

LastModifiedDate

11/04/2009