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General NPI Number Information
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NPI Number | 1083056204
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Entity Type | Organization
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Legal Business Name | KAREN KOO DDS DENTAL CORP.
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Dates
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Enumeration Date | 07/30/2013
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Last Update Date | 07/30/2013
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Provider Practice Location Address
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Address Line | 936 E IMPERIAL HWY
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City | BREA
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State | CA
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Zip | 92821-5612
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Country | US
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Telephone | 714-990-4911
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Fax | 714-990-5883
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Provider Business Mailing Address
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Address Line | 936 E IMPERIAL HWY
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City | BREA
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State | CA
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Zip | 92821-5612
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Country | US
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Telephone | 714-990-4911
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Fax | 714-990-5883
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KAREN KOO
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Credential | D.D.S.
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Telephone | 714-990-4911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 52071
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License Number State | CA
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