Moutaz Kotrob, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

55981 Issued in CA

Practice address

1133 El Camino Real Ste 5
# B -304
South San Francisco, CA 94080-3288

Phone

(650) 244-9928

Fax

(650) 244-9284

NPI assigned

Sep 21, 2007

Last updated

Mar 12, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pure Smile Dental Group

  • Dental Clinic/Center
  • South San Francisco, CA
  • NPI 1609141274
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1190332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1331510400000",
    "number": "1043406283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1133 EL CAMINO REAL STE 5",
            "address_2": "# B -304",
            "city": "SOUTH SAN FRANCISCO",
            "state": "CA",
            "postal_code": "940803288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1133 EL CAMINO REAL STE 5",
            "address_2": "# B -304",
            "city": "SOUTH SAN FRANCISCO",
            "state": "CA",
            "postal_code": "940803288",
            "telephone_number": "650-244-9928",
            "fax_number": "650-244-9284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOTROB",
        "first_name": "MOUTAZ",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-09-21",
        "last_updated": "2012-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "55981",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shahnaz B. Koegler, MD
• Esther Koeshadi, PHARM.D.
• Daniel L. Kong, MD
• Nicole Kong, PHARMD
• Joseph Andrew Kopshever, PT
• KRJ Healthcare, LLC. (KRJ Home Care)
• Anthony Tyrone Ku, DDS
• Camie Kuo, RN, FNP-C
• Jenny Kuo, MD MBA
• Alice Kwan, M.D.

• General Practice Dentistry in South San Francisco, CA
• Providers in South San Francisco, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.