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General NPI Number Information
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NPI Number | 1679853063
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Entity Type | Individual
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Provider Name | MYUNGSUK KOH DMD
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Gender | Male
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Dates
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Enumeration Date | 08/17/2011
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Last Update Date | 03/19/2019
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Provider Practice Location Address
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Address Line | 302 JAMERSON CT
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City | GLEN ALLEN
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State | VA
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Zip | 23059-5678
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Country | US
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Telephone | 781-535-2834
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Fax |
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Provider Business Mailing Address
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Address Line | 4017 LAUDERDALE DR
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City | HENRICO
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State | VA
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Zip | 23233-1082
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Country | US
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Telephone | 804-913-1710
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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 | 0401413547
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN1855839
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License Number State | MA
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