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General NPI Number Information
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NPI Number | 1720602444
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Entity Type | Organization
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Legal Business Name | ANNABEL S. KOA , DMD INC
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Dates
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Enumeration Date | 05/29/2020
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Last Update Date | 05/29/2020
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Provider Practice Location Address
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Address Line | 400 N SAN MATEO DR STE 2
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City | SAN MATEO
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State | CA
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Zip | 94401-2418
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Country | US
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Telephone | 650-484-8851
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Fax |
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Provider Business Mailing Address
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Address Line | 6419 BRANDO LOOP
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City | FAIR OAKS
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State | CA
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Zip | 95628-3764
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Country | US
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Telephone | 650-278-6055
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Fax |
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Authorized Official
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Title or Position | DENTAL BILLER
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Name | JUVITH BING PALADO-VELASCO
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Credential |
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Telephone | 650-484-8851
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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