Joanna Koo, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

105067 Issued in CA

Practice address

19040 Van Buren Blvd Ste 111
Riverside, CA 92508-9160

Phone

(951) 789-0200

NPI assigned

Jul 22, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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

• Sopheap Tang DMD Dental Corporation

  dba A Tooth Fairy Dental Office of Sopheap Tang, DMD

  • General Practice Dentistry
  • Riverside, CA
  • NPI 1255610242
  NPD (past)

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

{
    "created_epoch": "1595376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595462400000",
    "number": "1093323354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7630 CANBERRA WAY",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925086067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19040 VAN BUREN BLVD STE 111",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925089160",
            "telephone_number": "951-789-0200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "31577 Canyon Estates Dr Ste 205",
            "address_purpose": "LOCATION",
            "city": "Lake Elsinore",
            "state": "CA",
            "postal_code": "925320467",
            "country_code": "US",
            "telephone_number": "951-674-6900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOO",
        "first_name": "JOANNA",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-07-22",
        "last_updated": "2020-07-23",
        "certification_date": "2020-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "105067",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@atoothfairy.com",
            "affiliation": "N",
            "address_1": "19040 Van Buren Blvd Ste 111",
            "city": "Riverside",
            "state": "CA",
            "country_code": "US",
            "postal_code": "925089160",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Erwin Kong
• Fernando Kong
• Vincent Kong, DO
• David Anthony Konzem, PA-C
• Chulhwe Koo, M.D.
• John Daniel Koontz, MD
• Juan Carlo Koontz
• Analira Koopman
• Truazul P Korazonazul
• Vivekanand Korde, CIP

• Dentist in Riverside, CA
• Providers in Riverside, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2020; 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.