Provider Demographics
NPI:1124017785
Name:VANG, KOU B (DDS)
Entity Type:Individual
Prefix:DR
First Name:KOU
Middle Name:B
Last Name:VANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:225 UNIVERSITY AVE W
Mailing Address - Street 2:SUITE 124
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55103-2072
Mailing Address - Country:US
Mailing Address - Phone:651-222-6738
Mailing Address - Fax:651-848-0808
Practice Address - Street 1:225 UNIVERSITY AVE W
Practice Address - Street 2:SUITE 124
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55103-2072
Practice Address - Country:US
Practice Address - Phone:651-222-6738
Practice Address - Fax:651-848-0808
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSD11210122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist