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General NPI Number Information
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NPI Number | 1992212310
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Entity Type | Organization
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Legal Business Name | K-TECH DENTAL GROUP, PC
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Dates
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Enumeration Date | 01/08/2018
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Last Update Date | 02/05/2024
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Provider Practice Location Address
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Address Line | 14016 SULLYFIELD CIR STE B
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City | CHANTILLY
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State | VA
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Zip | 20151-4010
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Country | US
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Telephone | 703-815-0699
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Fax |
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Provider Business Mailing Address
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Address Line | 14016 SULLYFIELD CIR STE B
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City | CHANTILLY
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State | VA
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Zip | 20151-4010
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Country | US
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Telephone | 703-815-0699
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PHILIP I. KOH
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Credential | DDS, MSD
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Telephone | 703-815-0699
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 0401411961
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License Number State | VA
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