Jack H Koumjian, DDS

Primary specialty

ProsthodonticsTaxonomy code 1223P0700X

License

327301 Issued in CA

Practice address

770 Welch Rd
Ste 280
Palo Alto, CA 94304-1513

Phone

(650) 347-3426

Fax

(650) 324-0103

NPI assigned

Aug 21, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1198108800000",
    "number": "1073629390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "770 WELCH RD",
            "address_2": "STE 280",
            "city": "PALO ALTO",
            "state": "CA",
            "postal_code": "943041513",
            "telephone_number": "650-347-3426",
            "fax_number": "650-324-0103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "770 WELCH RD",
            "address_2": "STE 280",
            "city": "PALO ALTO",
            "state": "CA",
            "postal_code": "943041513",
            "telephone_number": "650-347-3426",
            "fax_number": "650-324-0103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOUMJIAN",
        "first_name": "JACK",
        "middle_name": "H",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-21",
        "last_updated": "2007-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "CA",
            "license": "327301",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTICAL",
            "identifier": "1073629390",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ruby E. Koshy, M.D.
• Colin Koster
• Valentyna Kostiuk
• Shelli Diane Koszdin, PHARM.D.
• Loraine Diane Kott
• Alexandra Faye Kovar, M.D.
• Caryn Gold Kovar, PH.D.
• Bernardo Kracer, M.D.
• Kathleen Kramer, MD
• Natasha Michelle Kramer

• Prosthodontics in Palo Alto, CA
• Providers in Palo Alto, CA by specialty
• Prosthodontics in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.