Provider Demographics
NPI:1508997115
Name:KOOPAH, ALI REZA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:REZA
Last Name:KOOPAH
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 1:166 GEARY ST
Mailing Address - Street 2:8TH FLOOR
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-5602
Mailing Address - Country:US
Mailing Address - Phone:415-421-2652
Mailing Address - Fax:415-421-0939
Practice Address - Street 1:166 GEARY ST
Practice Address - Street 2:8TH FLOOR
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-5602
Practice Address - Country:US
Practice Address - Phone:415-421-2652
Practice Address - Fax:415-421-0939
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA398261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice