Provider Demographics
NPI:1003840562
Name:KOH, DAVIS Y (DPT, MBA, GCS, CSCS)
Entity Type:Individual
Prefix:
First Name:DAVIS
Middle Name:Y
Last Name:KOH
Suffix:
Gender:M
Credentials:DPT, MBA, GCS, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9080 IRVINE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-4658
Mailing Address - Country:US
Mailing Address - Phone:949-540-5641
Mailing Address - Fax:
Practice Address - Street 1:9080 IRVINE CENTER DR
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-4658
Practice Address - Country:US
Practice Address - Phone:949-540-5641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT21306225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT0213060OtherBLUE SHIELD
CAP00197420OtherRAILROAD MEDICARE
CAPT0213060Medicaid
CAPT21306OtherSTATE LICENSE NUMBER
CAPT0213060OtherBLUE SHIELD