Koda Plastic Surgery

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

Legal business name

KODA PLASTIC SURGERY

Practice address

9097 E Desert Cove Ave Ste 100
Scottsdale, AZ 85260-6276

Phone

(616) 914-8894

Fax

(480) 701-4990

NPI assigned

Jun 5, 2024

Organization subpart

No

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

Authorized official

Name

Alicia A Raghib, MEDICAL ASSISTANT

Title

Practice Manager

Phone

(616) 914-8894

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1717545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718150400000",
    "number": "1336980069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9097 E DESERT COVE AVE STE 100",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852606276",
            "telephone_number": "616-914-8894",
            "fax_number": "480-701-4990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9097 E DESERT COVE AVE STE 100",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852606276",
            "telephone_number": "616-914-8894",
            "fax_number": "480-701-4990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KODA PLASTIC SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-05",
        "last_updated": "2024-06-12",
        "certification_date": "2024-06-12",
        "status": "A",
        "authorized_official_last_name": "RAGHIB",
        "authorized_official_first_name": "ALICIA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "616-914-8894",
        "authorized_official_credential": "MEDICAL ASSISTANT"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole C. Koch, PT, DPT
• Robert James Koch, DMD
• Genevie Loree Kocourek, M.D.
• Jacob John Koczman, M.D.
• Kaitlin Koczman
• Lavanya Kodali, MD
• Syed Matthew Kodilinye, MBBS
• Tony James Koehler, DC
• Adam R Koelsch, M.D.
• Babette Witkind Koenig, D.O.

• Plastic and Reconstructive Surgery Physician in Scottsdale, AZ
• Providers in Scottsdale, AZ by specialty
• Plastic and Reconstructive Surgery Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2024; 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.