Healthcare Provider Details

I. General information

NPI: 1740427863
Provider Name (Legal Business Name): EILEEN LAO COCJIN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2009
Last Update Date: 01/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 E 25TH ST #277
KANSAS CITY MO
64108-2716
US

IV. Provider business mailing address

650 E 25TH ST #277
KANSAS CITY MO
64108-2716
US

V. Phone/Fax

Practice location:
  • Phone: 816-235-2121
  • Fax: 816-235-5526
Mailing address:
  • Phone: 816-235-2121
  • Fax: 816-235-5526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2008030993
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: