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General NPI Number Information
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NPI Number | 1699803049
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Entity Type | Individual
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Provider Name | BERNARD KOO DDS
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Gender | Male
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 420 ORD ST SUITE 102-A
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City | LOS ANGELES
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State | CA
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Zip | 90012-2834
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Country | US
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Telephone | 213-617-0136
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Fax |
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Provider Business Mailing Address
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Address Line | 1490 ATOLL
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City | WEST COVINA
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State | CA
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Zip | 91790-3383
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Country | US
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Telephone | 626-960-9660
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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 | 37437
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License Number State | CA
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