Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | A49942 | CA |
NPI | 1568876142 |
---|---|
Provider Name | Mr. Ronald James Koch JR. |
First Address | Mountain View, CA 94040-4211 |
Second Address | Mountain View, CA 94040-4211 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2014 |
Last Update Date | 03/04/2018 |