Provider Demographics
NPI:1427270222
Name:ALEXANDER A KOGAN DDS, INC
Entity type:Organization
Organization Name:ALEXANDER A KOGAN DDS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:A
Authorized Official - Last Name:KOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:415-644-0644
Mailing Address - Street 1:255 KING STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-1790
Mailing Address - Country:US
Mailing Address - Phone:415-644-0644
Mailing Address - Fax:415-644-0646
Practice Address - Street 1:255 KING ST STE A
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-1790
Practice Address - Country:US
Practice Address - Phone:415-644-0644
Practice Address - Fax:415-644-0646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46626122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty