Individual
JACK H KOUMJIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
770 WELCH RD, STE 280, PALO ALTO, CA 94304-1513
(650) 347-3426
(650) 324-0103
Mailing address
770 WELCH RD, STE 280, PALO ALTO, CA 94304-1513
(650) 347-3426
(650) 324-0103
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
327301
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1073629390
DENTICAL
CA
Enumeration date
08/21/2006
Last updated
12/20/2007
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