Provider Demographics
NPI:1518290600
Name:KOH, STANLEY GEUN (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:GEUN
Last Name:KOH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5130 LA JOLLA BLVD
Mailing Address - Street 2:UNIT 3K
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-1004
Mailing Address - Country:US
Mailing Address - Phone:310-850-1395
Mailing Address - Fax:
Practice Address - Street 1:5130 LA JOLLA BLVD
Practice Address - Street 2:UNIT 3K
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-1004
Practice Address - Country:US
Practice Address - Phone:310-850-1395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98602207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACQ312ZMedicare PIN