Provider Demographics
NPI:1093773277
Name:ANNIE GOH DDS
Entity Type:Organization
Organization Name:ANNIE GOH DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-530-0900
Mailing Address - Street 1:25897 WESTERN AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-3359
Mailing Address - Country:US
Mailing Address - Phone:310-530-0900
Mailing Address - Fax:310-530-8508
Practice Address - Street 1:25897 WESTERN AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-3359
Practice Address - Country:US
Practice Address - Phone:310-530-0900
Practice Address - Fax:310-530-8508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB40937122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty