Provider Demographics
NPI:1992798326
Name:KOICHEFF, NEVANNA INGEBORG (DDS)
Entity type:Individual
Prefix:DR
First Name:NEVANNA
Middle Name:INGEBORG
Last Name:KOICHEFF
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:452002 MITSCHER WAY
Mailing Address - Street 2:BLDG 2495
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92145
Mailing Address - Country:US
Mailing Address - Phone:619-754-3223
Mailing Address - Fax:
Practice Address - Street 1:452002 MITSCHER WAY
Practice Address - Street 2:BLDG 2495
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92145
Practice Address - Country:US
Practice Address - Phone:619-754-3223
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0448261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice