Provider Demographics
NPI:1205956893
Name:KOO, DICK WING (DDS)
Entity type:Individual
Prefix:DR
First Name:DICK
Middle Name:WING
Last Name:KOO
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 1:827 BLOSSOM HILL RD
Mailing Address - Street 2:SUITE E-8
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-2701
Mailing Address - Country:US
Mailing Address - Phone:408-578-4700
Mailing Address - Fax:408-578-5730
Practice Address - Street 1:827 BLOSSOM HILL RD
Practice Address - Street 2:SUITE E-8
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-2701
Practice Address - Country:US
Practice Address - Phone:408-578-4700
Practice Address - Fax:408-578-5730
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA334831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice