Provider Demographics
NPI:1639187800
Name:LUNDGREN-KOSZEGHY, KRISTIAN (DMD, MMSC)
Entity Type:Individual
Prefix:
First Name:KRISTIAN
Middle Name:
Last Name:LUNDGREN-KOSZEGHY
Suffix:
Gender:M
Credentials:DMD, MMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 LA PLAYA ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-3262
Mailing Address - Country:US
Mailing Address - Phone:415-221-5592
Mailing Address - Fax:415-221-8826
Practice Address - Street 1:850 MIDDLEFIELD RD STE 1
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2918
Practice Address - Country:US
Practice Address - Phone:650-326-1400
Practice Address - Fax:650-326-2909
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA519671223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA51967OtherDENTAL LICENSE NUMBER