Provider Demographics
NPI:1700859998
Name:KOH, PHILIP D (DDS)
Entity Type:Individual
Prefix:MRS
First Name:PHILIP
Middle Name:D
Last Name:KOH
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 1:2509 W MCFADDEN AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-2747
Mailing Address - Country:US
Mailing Address - Phone:714-835-8797
Mailing Address - Fax:714-835-8798
Practice Address - Street 1:2509 W MCFADDEN AVE
Practice Address - Street 2:SUITE-E
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-2747
Practice Address - Country:US
Practice Address - Phone:714-835-8797
Practice Address - Fax:714-835-8798
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA371251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice