Provider Demographics
NPI:1033411004
Name:KOH, MARVIN TECK HAAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:TECK HAAN
Last Name:KOH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 HANA WAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3885
Mailing Address - Country:US
Mailing Address - Phone:916-983-2262
Mailing Address - Fax:916-983-5214
Practice Address - Street 1:785 HANA WAY
Practice Address - Street 2:SUITE 201
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3885
Practice Address - Country:US
Practice Address - Phone:916-983-2262
Practice Address - Fax:916-983-5214
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-24
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA532321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice