Provider Demographics
NPI:1083056204
Name:KAREN KOO DDS DENTAL CORP.
Entity Type:Organization
Organization Name:KAREN KOO DDS DENTAL CORP.
Other - Org Name:BREA RANCH DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-990-4911
Mailing Address - Street 1:936 E IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-5612
Mailing Address - Country:US
Mailing Address - Phone:714-990-4911
Mailing Address - Fax:714-990-5883
Practice Address - Street 1:936 E IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-5612
Practice Address - Country:US
Practice Address - Phone:714-990-4911
Practice Address - Fax:714-990-5883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52071261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental