Provider Demographics
NPI:1568617876
Name:DAVID C KOO DDS INC
Entity Type:Organization
Organization Name:DAVID C KOO DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:KOO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-445-1181
Mailing Address - Street 1:111 E LIVE OAK AVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-5240
Mailing Address - Country:US
Mailing Address - Phone:626-445-1181
Mailing Address - Fax:
Practice Address - Street 1:111 E LIVE OAK AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-5240
Practice Address - Country:US
Practice Address - Phone:626-445-1181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35925122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty