Individual
DR. PHILIP I KOH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
14016 SULLYFIELD CIR STE B, CHANTILLY, VA 20151-4010
(703) 815-0699
(703) 815-0692
Mailing address
14016 SULLYFIELD CIR STE B, CHANTILLY, VA 20151-4010
(703) 815-0699
(703) 815-0692
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
2901019018
MI
1223G0001X
General Practice Dentistry
Primary
2901019018
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1958112110
BCBS OF MI MED SURGICAL
MI
01
—
D910180
BCBS OF MI DENTAL
MI
Enumeration date
03/19/2007
Last updated
02/05/2024
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