Provider Demographics
NPI:1275947160
Name:KOGAN, ALEXANDER A (DDS)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:A
Last Name:KOGAN
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 1:11 KIMMIE CT
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-1634
Mailing Address - Country:US
Mailing Address - Phone:415-602-4123
Mailing Address - Fax:
Practice Address - Street 1:14895 E 14TH ST
Practice Address - Street 2:#100
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-2922
Practice Address - Country:US
Practice Address - Phone:415-602-4123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46626122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist