Provider Demographics
NPI:1134364748
Name:SANDY S KOH M.D., INC
Entity type:Organization
Organization Name:SANDY S KOH M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:S
Authorized Official - Last Name:KOH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-350-2196
Mailing Address - Street 1:3419 TYLER AVE
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-3103
Mailing Address - Country:US
Mailing Address - Phone:626-350-2197
Mailing Address - Fax:626-350-2111
Practice Address - Street 1:2727 PECK RD
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-2434
Practice Address - Country:US
Practice Address - Phone:626-350-2196
Practice Address - Fax:626-350-4030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34583208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1083726905Medicaid
CA1245398700Medicaid