Provider Demographics
NPI:1720532450
Name:NIEUWKOOP, KORY (BS, RDH, RDHAP)
Entity Type:Individual
Prefix:
First Name:KORY
Middle Name:
Last Name:NIEUWKOOP
Suffix:
Gender:F
Credentials:BS, RDH, RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23171 ROAD 7
Mailing Address - Street 2:
Mailing Address - City:CHOWCHILLA
Mailing Address - State:CA
Mailing Address - Zip Code:93610-9204
Mailing Address - Country:US
Mailing Address - Phone:559-706-8741
Mailing Address - Fax:
Practice Address - Street 1:23171 ROAD 7
Practice Address - Street 2:
Practice Address - City:CHOWCHILLA
Practice Address - State:CA
Practice Address - Zip Code:93610-9204
Practice Address - Country:US
Practice Address - Phone:559-706-8741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30113124Q00000X
IDDH-3275124Q00000X
CA684124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12Medicaid