Provider Demographics
NPI:1295465367
Name:KATCHOOI DENTAL GROUP INC
Entity Type:Organization
Organization Name:KATCHOOI DENTAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KATCHOOI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:478-390-1960
Mailing Address - Street 1:7814 INCEPTION WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-5122
Mailing Address - Country:US
Mailing Address - Phone:478-390-1960
Mailing Address - Fax:
Practice Address - Street 1:12630 MONTE VISTA RD STE 108
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2526
Practice Address - Country:US
Practice Address - Phone:858-312-5242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty