Provider Demographics
NPI:1558663500
Name:KOCHUBEY, SOFYA V (DENURIST)
Entity Type:Individual
Prefix:MS
First Name:SOFYA
Middle Name:V
Last Name:KOCHUBEY
Suffix:
Gender:F
Credentials:DENURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5904 N 45TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98407-1902
Mailing Address - Country:US
Mailing Address - Phone:253-238-1783
Mailing Address - Fax:
Practice Address - Street 1:5904 N 45TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98407-1902
Practice Address - Country:US
Practice Address - Phone:253-238-1783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-24
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN60141899122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist