Provider Demographics
NPI:1821136714
Name:KOOK, DOUK
Entity Type:Individual
Prefix:DR
First Name:DOUK
Middle Name:
Last Name:KOOK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 S MASON RD
Mailing Address - Street 2:STE. 144
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-3898
Mailing Address - Country:US
Mailing Address - Phone:832-437-9154
Mailing Address - Fax:832-437-9157
Practice Address - Street 1:1475 SAWDUST RD
Practice Address - Street 2:APT. #8203
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77380-2145
Practice Address - Country:US
Practice Address - Phone:520-245-3164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALD7089Medicaid