Provider Demographics
NPI:1770659716
Name:WOHN, KUMZOO (DDS)
Entity Type:Individual
Prefix:
First Name:KUMZOO
Middle Name:
Last Name:WOHN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10600 WILKINS AVE
Mailing Address - Street 2:#1C
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-6078
Mailing Address - Country:US
Mailing Address - Phone:310-475-5122
Mailing Address - Fax:
Practice Address - Street 1:4165 BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-4418
Practice Address - Country:US
Practice Address - Phone:323-662-2141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43409122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist