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NPI Code Detail

MEDICARE: BRADLEY KOU

MEDICARE: BRADLEY KOU
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
21223G0001XGeneral Practice Dentistry36053TX

General Provider Information

NPI Number : 1912468935
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRADLEY KOU
Provider Business Mailing Address
First Line : 525 E MARKET ST
Second Line :
City : AKRON
State : OH
Zip : 44304-1619
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 75 ARCH ST STE 303
Second Line :
City : AKRON
State : OH
Zip : 44304-1432
Country : US
Telephone Number : 330-375-6262
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2019
Last Update Date : 08/27/2020

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Directions to “ BRADLEY KOU ” Practice Location

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