Healthcare Provider Details

I. General information

NPI: 1134364748
Provider Name (Legal Business Name): SANDY S KOH M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2008
Last Update Date: 12/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 PECK RD
EL MONTE CA
91733-2434
US

IV. Provider business mailing address

3419 TYLER AVE
EL MONTE CA
91731-3103
US

V. Phone/Fax

Practice location:
  • Phone: 626-350-2196
  • Fax: 626-350-4030
Mailing address:
  • Phone: 626-350-2197
  • Fax: 626-350-2111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA34583
License Number StateCA

VIII. Authorized Official

Name: DR. SANDY S KOH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 626-350-2196