Provider Demographics
NPI:1770817199
Name:KOA, ANNABEL SY (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANNABEL
Middle Name:SY
Last Name:KOA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N SAN MATEO DR
Mailing Address - Street 2:SUITE #2
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2418
Mailing Address - Country:US
Mailing Address - Phone:650-343-0895
Mailing Address - Fax:650-343-2441
Practice Address - Street 1:400 N SAN MATEO DR
Practice Address - Street 2:SUITE #2
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2418
Practice Address - Country:US
Practice Address - Phone:650-343-0895
Practice Address - Fax:650-343-2441
Is Sole Proprietor?:No
Enumeration Date:2009-10-01
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFK12628031223G0001X
CADDS528771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice