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General NPI Number Information
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NPI Number | 1003827395
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Entity Type | Organization
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Legal Business Name | KOH DENTAL CORPORATION
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2509 W MCFADDEN AVE SUITE E
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City | SANTA ANA
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State | CA
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Zip | 92704-2747
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Country | US
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Telephone | 714-835-8797
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Fax | 714-835-8797
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Provider Business Mailing Address
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Address Line | 2509 W MCFADDEN AVE SUITE E
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City | SANTA ANA
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State | CA
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Zip | 92704-2747
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Country | US
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Telephone | 714-835-8797
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Fax | 714-835-8798
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Authorized Official
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Title or Position | OWNER
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Name | PHILIP D KOH SR.
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Credential | DDS
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Telephone | 714-835-8797
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 53415
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 3712501
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License Number State | CA
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