Provider Demographics
NPI:1215135579
Name:KOH, RICHARD USANG (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:USANG
Last Name:KOH
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3551 FARQUHAR AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2003
Mailing Address - Country:US
Mailing Address - Phone:562-598-3383
Mailing Address - Fax:562-936-1163
Practice Address - Street 1:3551 FARQUHAR AVE STE 204
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2003
Practice Address - Country:US
Practice Address - Phone:562-598-3383
Practice Address - Fax:562-936-1163
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA593291223P0300X, 1223P0300X
VA04014137371223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics