Provider Demographics
NPI:1417976473
Name:KAY, SOPHAN REATH (DDS)
Entity Type:Individual
Prefix:DR
First Name:SOPHAN
Middle Name:REATH
Last Name:KAY
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 1:9180 N COACHLINE BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85743-7360
Mailing Address - Country:US
Mailing Address - Phone:520-577-0035
Mailing Address - Fax:520-577-0044
Practice Address - Street 1:9180 N COACHLINE BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85743-7360
Practice Address - Country:US
Practice Address - Phone:520-577-0035
Practice Address - Fax:520-577-0044
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD52541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice