Healthcare Provider Details

I. General information

NPI: 1568876142
Provider Name (Legal Business Name): RONALD JAMES KOCH JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 04/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 SOUTH DR STE 115
MOUNTAIN VIEW CA
94040-4211
US

IV. Provider business mailing address

525 SOUTH DR STE 115
MOUNTAIN VIEW CA
94040-4211
US

V. Phone/Fax

Practice location:
  • Phone: 650-969-5600
  • Fax: 650-969-0360
Mailing address:
  • Phone: 650-969-5600
  • Fax: 650-969-0360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberA49942
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: