Provider Demographics
NPI:1912460619
Name:YOUNG SEONG KOH D.D.S. PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:YOUNG SEONG KOH D.D.S. PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:YOUNG
Authorized Official - Middle Name:SEONG
Authorized Official - Last Name:KOH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-499-4126
Mailing Address - Street 1:15890 GALE AVE
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-1601
Mailing Address - Country:US
Mailing Address - Phone:626-333-0111
Mailing Address - Fax:626-333-0111
Practice Address - Street 1:15890 GALE AVE
Practice Address - Street 2:
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-1601
Practice Address - Country:US
Practice Address - Phone:626-333-0111
Practice Address - Fax:626-333-2400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental