Provider Demographics
NPI:1225233125
Name:KOO, KAREN (DDS)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:KOO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8479 SUNSHINE LN
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-7117
Mailing Address - Country:US
Mailing Address - Phone:951-780-4178
Mailing Address - Fax:
Practice Address - Street 1:160 N LURING DR
Practice Address - Street 2:SUITE F
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-6840
Practice Address - Country:US
Practice Address - Phone:760-325-2503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA520711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice