Koch, Jack A

Koch, Jack A is an sole proprietor health care provider with primary practice located at 425 W Bonita Ave Ste 110 , San Dimas CA 91773-2543. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Podiatrist, which is considered as his primary health care specialty. Koch, Jack A can be contacted via phone (714) 990-9153.

Contact Information

Primary practice address
425 W Bonita Ave Ste 110 San Dimas CA 91773-2543
Phone: (714) 990-9153
Fax: (714) 990-9154
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X E2255 California

Profile Details

NPI number 1447275748
LBN Legal business name Koch, Jack A
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 13th, 2006
Last updated Sep 26th, 2017 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1447275748 NPPES
California MEDICAID 000E22551
California Other 480005415

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