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General NPI Number Information
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NPI Number | 1639187800
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Entity Type | Individual
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Provider Name | KRISTIAN LUNDGREN-KOSZEGHY DMD, MMSC.
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Gender | Male
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 11/21/2018
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Provider Practice Location Address
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Address Line | 850 MIDDLEFIELD RD STE 1
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City | PALO ALTO
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State | CA
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Zip | 94301-2918
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Country | US
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Telephone | 650-326-1400
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Fax | 650-326-2909
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Provider Business Mailing Address
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Address Line | 760 LA PLAYA ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94121-3262
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Country | US
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Telephone | 415-221-5592
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Fax | 415-221-8826
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 51967
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License Number State | CA
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