Provider Demographics
NPI:1891843439
Name:KOONER, RANJIT SINGH (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANJIT
Middle Name:SINGH
Last Name:KOONER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12455 MILES STREET
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-7838
Mailing Address - Country:US
Mailing Address - Phone:562-924-1482
Mailing Address - Fax:562-860-7512
Practice Address - Street 1:12455 MILES STREET
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-7838
Practice Address - Country:US
Practice Address - Phone:562-924-1482
Practice Address - Fax:562-860-7512
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30236122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD30236Medicaid