Provider Demographics
NPI:1871609271
Name:KOH, JOSHUA KRITSADA (MD)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:KRITSADA
Last Name:KOH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2058 N MILLS AVE
Mailing Address - Street 2:#518
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-2812
Mailing Address - Country:US
Mailing Address - Phone:909-599-4422
Mailing Address - Fax:909-599-5577
Practice Address - Street 1:1173 N DIXIE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-1200
Practice Address - Country:US
Practice Address - Phone:909-599-4422
Practice Address - Fax:909-599-5577
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA509362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA50936OtherMEDCIAL LICENSE #
CA00A509360Medicaid
CA00A509360Medicaid
CABK4317752OtherDEA #
CAA50936OtherMEDCIAL LICENSE #