Healthcare Provider Details

I. General information

NPI: 1821106949
Provider Name (Legal Business Name): KELLY KOCHAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

344 MAIN STREET SUITE 002
MOUNT KISCO NY
10549
US

IV. Provider business mailing address

344 MAIN STREET SUITE 002
MOUNT KISCO NY
10549
US

V. Phone/Fax

Practice location:
  • Phone: 914-244-4414
  • Fax: 914-244-4404
Mailing address:
  • Phone: 914-244-4414
  • Fax: 914-244-4404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number041287
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: