Provider Demographics
NPI:1992275101
Name:KOH, ANDY SEUNG HOON (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDY
Middle Name:SEUNG HOON
Last Name:KOH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CONSTITUTION PLZ APT 916
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06103-1831
Mailing Address - Country:US
Mailing Address - Phone:213-215-7752
Mailing Address - Fax:
Practice Address - Street 1:250 LAMBERTON RD
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-2149
Practice Address - Country:US
Practice Address - Phone:860-688-3663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-30
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2.012304122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist