Provider Demographics
NPI:1376504076
Name:KOSHKI, MOEIZ (DDS)
Entity Type:Individual
Prefix:DR
First Name:MOEIZ
Middle Name:
Last Name:KOSHKI
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 1:1260 15TH ST
Mailing Address - Street 2:#805
Mailing Address - City:SANTA MONIA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-1143
Mailing Address - Country:US
Mailing Address - Phone:310-395-1261
Mailing Address - Fax:310-395-6645
Practice Address - Street 1:1260 15TH ST
Practice Address - Street 2:#805
Practice Address - City:SANTA MONIA
Practice Address - State:CA
Practice Address - Zip Code:90404-1143
Practice Address - Country:US
Practice Address - Phone:310-395-1261
Practice Address - Fax:310-395-6645
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44505122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist