Provider Demographics
NPI:1841576444
Name:COUGHLIN, CHRISTINE JI-HAE (DDS)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:JI-HAE
Last Name:COUGHLIN
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 1:914 SOUTH VERMONT AVE.
Mailing Address - Street 2:104
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006
Mailing Address - Country:US
Mailing Address - Phone:213-427-6070
Mailing Address - Fax:213-427-6077
Practice Address - Street 1:914 S. VERMONT AVE.
Practice Address - Street 2:104
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006
Practice Address - Country:US
Practice Address - Phone:213-427-6070
Practice Address - Fax:213-427-6077
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60844122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist