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NPI Code Detail

MEDICARE: DUANE KOH

MEDICARE:   DUANE  KOH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1760897300
Entity Type Code : Individual
Provider Name (Legal Business Name) : DUANE KOH
Provider Business Mailing Address
First Line : 16843 ROOSEVELT LN
Second Line :
City : HUNTINGTON BEACH
State : CA
Zip : 92649-4002
Country : US
Telephone Number : 310-963-8523
Fax Number :
Provider Business Practice Location Address
First Line : 333 CITY BLVD W STE 2150
Second Line :
City : ORANGE
State : CA
Zip : 92868-5920
Country : US
Telephone Number : 714-456-6661
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2014
Last Update Date : 11/22/2021

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Directions to “ DUANE KOH ” Practice Location

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