Provider Demographics
NPI:1417945601
Name:STANLEY S KOH DDS INC
Entity Type:Organization
Organization Name:STANLEY S KOH DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL MAXILLOFACIAL SURGEON PRESIDEN
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:S
Authorized Official - Last Name:KOH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-327-2051
Mailing Address - Street 1:3301 19TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-3066
Mailing Address - Country:US
Mailing Address - Phone:661-327-2051
Mailing Address - Fax:661-633-1730
Practice Address - Street 1:3301 19TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-3066
Practice Address - Country:US
Practice Address - Phone:661-327-2051
Practice Address - Fax:661-633-1730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADY325721223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty