MEDICARE: DR. JASON KOH DDS

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
1	1223E0200X	Endodontics	DEN.00203936	CO

General Provider Information

NPI Number	:	1770889305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON KOH DDS

Provider Business Mailing Address
First Line	:	3405 S YARROW ST UNIT D
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80227-4901
Country	:	US
Telephone Number	:	303-458-0444
Fax Number	:

Provider Business Practice Location Address
First Line	:	3405 S YARROW ST
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80227-4965
Country	:	US
Telephone Number	:	303-647-5382
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2011
Last Update Date	:	11/06/2023

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