Healthcare Provider Details

I. General information

NPI: 1598046849
Provider Name (Legal Business Name): KRASNA SENG KUOCH D.N., P.M.D (IP) DEM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2011
Last Update Date: 02/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5150 BUFORD HWY NE SUITE A120
DORAVILLE GA
30340-1153
US

IV. Provider business mailing address

5150 BUFORD HWY NE SUITE A120
DORAVILLE GA
30340-1153
US

V. Phone/Fax

Practice location:
  • Phone: 770-597-8181
  • Fax:
Mailing address:
  • Phone: 770-986-9338
  • Fax: 770-986-9337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172P00000X
TaxonomyNaprapath
License Number181.000330
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: