JACK A KOCH (NPI# 1447275748) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447275748 |
| Entity Type | Individual |
| Full Name | JACK A KOCH |
| Credential | DPM |
| Practice Address |
425 W Bonita Ave Ste 110 San Dimas CA 91773-2543 |
| Mailing Address |
2937 Cardamon Ln Fullerton CA 92835-4307 |
| Practice Telephone | 7149909153 |
| Practice Fax Number | 7149909154 |
| Mailing Telephone | 7149909153 |
| Mailing Fax Number | 7149909154 |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2017-09-26 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 213E00000X | Podiatrist | E2255 | CA | Podiatric Medicine & Surgery Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | RAILROAD | 480005415 | 01 |
| CA | 000E22551 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114923737 | Jack L. Koch Jr. | Psychiatry & Neurology | 2125 Belcourt Ave, Nashville, TN 37212-3503 | 2005-06-28 |
| 1184742074 | Jack L Koch | Counselor | 580 8th St, Carlyle, IL 62231-1803 | 2007-03-27 |
| Street Address |
425 W BONITA AVE STE 110 |
| City | SAN DIMAS |
| State | CA |
| Zip Code | 91773-2543 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639137425 | William G. Ayoub | Podiatrist | 425 W Bonita Ave Ste 110, San Dimas, CA 91773-2543 | 2006-05-02 |
| 1437542784 | Tiongson Foot & Ankle Care Inc. | Podiatrist | 425 W Bonita Ave Ste 110, San Dimas, CA 91773-2543 | 2015-03-11 |
| 1538348511 | Michael Couris Md | Ophthalmology | 425 W Bonita Ave Ste 110, San Dimas, CA | 2007-10-26 |
| 1295878247 | Ira A Diamond | Podiatrist | 425 W Bonita Ave Ste 110, San Dimas, CA 91773-2543 | 2007-02-15 |
| 1548314396 | Podiatry Group South A Proffessional Podiatry Corporation | Podiatrist | 425 W Bonita Ave Ste 110, San Dimas, CA 91773-2543 | 2007-01-22 |
| 1225106230 | Thomas E Smith Dpm | Podiatrist | 425 W Bonita Ave Ste 110, San Dimas, CA 91773-2543 | 2006-11-30 |
| 1598832172 | Geriatric Podiatry Medical Group Inc. | Podiatrist | 425 W Bonita Ave Ste 110, San Dimas, CA 91773-2543 | 2006-11-29 |
| 1780750729 | Ayoub Podiatry Group | Podiatrist | 425 W Bonita Ave Ste 110, San Dimas, CA 91773-2543 | 2006-11-28 |
| 1386710382 | Walker Podiatry Group | Podiatrist | 425 W Bonita Ave Ste 110, San Dimas, CA 91773-2543 | 2006-11-28 |
| 1578667283 | Lori B Birndorf Do A Medical Corporation | Ophthalmology | 425 W Bonita Ave Ste 110, San Dimas, CA 91773-2543 | 2006-09-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114533114 | Bonita Counseling Center | Marriage & Family Therapist | 425 W. Bonita Ave., Ste 204, San Dimas, CA 91773 | 2020-09-16 |
| 1457824419 | Georgina Almaraz | Case Manager/Care Coordinator | 677 Cliffside Dr Ste 677, San Dimas, CA 91773 | 2019-01-02 |
| 1922581560 | Readirides, Inc. | Non-emergency Medical Transport (VAN) | 451 W Bonita Ave Ste 14, San Dimas, CA 91773 | 2018-09-10 |
| 1710468376 | Marianne Shehata | Dentist | 925 Avenida Loma Vista, San Dimas, CA 91773 | 2018-08-22 |
| 1750875738 | Compassionate Hearts Home Health, Inc. | Home Health | 237 W Bonita Ave Ste F, San Dimas, CA 91773 | 2018-06-21 |
| 1548786056 | Era Life Care | Home Health | 1109 W San Bernardino Rd Suite 110, Covina, CA 91773 | 2017-08-16 |
| 1700302569 | Melanie Sabrina Schmuck | Physical Therapist | 1301 West Arrow Highway, Suite 130, San Dimas, CA 91773 | 2017-08-14 |
| 1811410111 | Nicole Geraldine Skinner | Social Worker | 762 W Cypress St, San Dimas, CA 91773 | 2017-07-19 |
| 1245760842 | Caren Senn | Dietitian, Registered | 917 Laramie Drive, San Dimas, CA 91773 | 2017-06-15 |
| 1417485020 | Young Mi Kim | Acupuncturist | 1121 Via Verde, San Dimas, CA 91773 | 2017-05-25 |
| Find all providers in zip 91773 | ||||
| Taxonomy Code | 213E00000X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| A podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639137425 | William G. Ayoub | Podiatrist | 425 W Bonita Ave Ste 110, San Dimas, CA 91773-2543 | 2006-05-02 |
| 1467420802 | William Gerald Goldblatt | Podiatrist | 322 N San Dimas Ave, San Dimas, CA 91773-2601 | 2006-03-10 |
| 1629358411 | Michael K Fairbanks Dpm A Professional Corporation | Podiatrist | 425 W Bonita Ave, Suite 110, San Dimas, CA 91773-2541 | 2011-08-24 |
| 1710118138 | William G Goldblatt Dpm A Professional Corporation | Podiatrist | 322 N San Dimas Ave, San Dimas, CA 91773-2601 | 2009-08-03 |
| 1780750729 | Ayoub Podiatry Group | Podiatrist | 425 W Bonita Ave Ste 110, San Dimas, CA 91773-2543 | 2006-11-28 |
| 1386710382 | Walker Podiatry Group | Podiatrist | 425 W Bonita Ave Ste 110, San Dimas, CA 91773-2543 | 2006-11-28 |
| 1942307764 | William H Tabb | Podiatrist | 425 W Bonita Ave, 110, San Dimas, CA 91773-2541 | 2006-09-20 |
| 1578678926 | Michael K Fairbanks | Podiatrist | 425 W Bonita Ave Ste 110, San Dimas, CA 91773-2543 | 2006-08-19 |
| 1417982950 | Thomas E Smith | Podiatrist | 425 W Bonita Ave Ste 110, San Dimas, CA 91773-2543 | 2006-07-12 |
| 1841225422 | William B Walker | Podiatrist | 425 W Bonita Ave Ste 110, San Dimas, CA 91773-2543 | 2006-07-11 |
| Find all providers in SAN DIMAS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.