Healthcare Provider Details

I. General information

NPI: 1992275101
Provider Name (Legal Business Name): ANDY SEUNG HOON KOH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2018
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 OLD BALLAS RD STE 118
CREVE COEUR MO
63141-7070
US

IV. Provider business mailing address

5 CONSTITUTION PLZ APT 916
HARTFORD CT
06103-1831
US

V. Phone/Fax

Practice location:
  • Phone: 314-948-8213
  • Fax:
Mailing address:
  • Phone: 213-215-7752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2020012730
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: