Provider Demographics
NPI:1720602444
Name:ANNABEL S. KOA , DMD INC
Entity Type:Organization
Organization Name:ANNABEL S. KOA , DMD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL BILLER
Authorized Official - Prefix:
Authorized Official - First Name:JUVITH
Authorized Official - Middle Name:BING
Authorized Official - Last Name:PALADO-VELASCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-484-8851
Mailing Address - Street 1:6419 BRANDO LOOP
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-3764
Mailing Address - Country:US
Mailing Address - Phone:650-278-6055
Mailing Address - Fax:
Practice Address - Street 1:400 N SAN MATEO DR STE 2
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2418
Practice Address - Country:US
Practice Address - Phone:650-484-8851
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA52877OtherDENTAL LICENSE