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General NPI Number Information
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NPI Number | 1144756719
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Entity Type | Individual
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Provider Name | MAHZAD KOOCHAKI
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Gender | Female
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Dates
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Enumeration Date | 05/02/2017
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Last Update Date | 07/26/2024
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Provider Practice Location Address
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Address Line | 20230 KATY FWY
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City | KATY
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State | TX
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Zip | 77449-7500
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Country | US
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Telephone | 281-717-9115
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 41
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City | KATY
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State | TX
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Zip | 77492-0146
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Country | US
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Telephone | 248-252-7778
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2901022326
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 39346
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License Number State | TX
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