Healthcare Provider Details

I. General information

NPI: 1659646487
Provider Name (Legal Business Name): JEFFREY FRANK KOCHER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2012
Last Update Date: 03/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18259 MAIN ST
JAMESTOWN CA
95327-9251
US

IV. Provider business mailing address

PO BOX 1340
JAMESTOWN CA
95327-1340
US

V. Phone/Fax

Practice location:
  • Phone: 209-984-3035
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number25923
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: