Provider Demographics
NPI:1841055688
Name:KOA DENTAL
Entity type:Organization
Organization Name:KOA DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:YOUNG
Authorized Official - Last Name:KANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-533-1958
Mailing Address - Street 1:3544 W OLYMPIC BLVD STE 118
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-3529
Mailing Address - Country:US
Mailing Address - Phone:323-735-0448
Mailing Address - Fax:323-735-4827
Practice Address - Street 1:3544 W OLYMPIC BLVD STE 118
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-3529
Practice Address - Country:US
Practice Address - Phone:323-735-0448
Practice Address - Fax:323-735-4827
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRIAN KANG DENTAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-20
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty