Healthcare Provider Details

I. General information

NPI: 1881604494
Provider Name (Legal Business Name): KRISTIAN LUNDGREN KOSZEGHY DMD MMSC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 MIDDLEFIELD RD STE #1
PALO ALTO CA
94301
US

IV. Provider business mailing address

850 MIDDLEFIELD RD STE #1
PALO ALTO CA
94301
US

V. Phone/Fax

Practice location:
  • Phone: 650-326-1400
  • Fax: 650-326-2909
Mailing address:
  • Phone: 650-326-1400
  • Fax: 650-326-2909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number51967
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number51967
License Number StateCA

VIII. Authorized Official

Name: KRISTIAN LUNDGREN-KOSZEGHY
Title or Position: PERIODONTIST
Credential: DMD MMSC
Phone: 650-326-1400