Provider Demographics
NPI:1053978924
Name:KOH, LANAH (DO)
Entity type:Individual
Prefix:
First Name:LANAH
Middle Name:
Last Name:KOH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1231 MAHARD PKWY
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-5710
Mailing Address - Country:US
Mailing Address - Phone:945-207-6500
Mailing Address - Fax:833-814-0098
Practice Address - Street 1:1231 MAHARD PKWY
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-5710
Practice Address - Country:US
Practice Address - Phone:945-207-6500
Practice Address - Fax:833-814-0090
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-25
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR2842021390200000X
TXV1814208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program