Provider Demographics
NPI:1336668110
Name:HOSS KM DENTAL GROUP, A PROFESSIONAL GROUP
Entity Type:Organization
Organization Name:HOSS KM DENTAL GROUP, A PROFESSIONAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:HOSS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:619-961-9867
Mailing Address - Street 1:9737 AERO DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1859
Mailing Address - Country:US
Mailing Address - Phone:619-636-2665
Mailing Address - Fax:
Practice Address - Street 1:9737 AERO DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1859
Practice Address - Country:US
Practice Address - Phone:619-636-2665
Practice Address - Fax:619-636-2665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-13
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA410161223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty