Individual
GREGORY LEE KOCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D
Contact information
Practice address
500 CITY PKWY W STE 200, ORANGE, CA 92868-2941
(714) 480-6760
Mailing address
500 CITY PKWY W STE 200, ORANGE, CA 92868-2941
(714) 480-6760
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY17893
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PSY17893
MEDICAL LICENSE
CA
Enumeration date
05/11/2006
Last updated
02/01/2021
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