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  5. TAKASHI KOYAMA, DMD, PHD, PA

TAKASHI KOYAMA, DMD, PHD, PA - Florida Company Profile

Company Details

Entity Name: TAKASHI KOYAMA, DMD, PHD, PA
Jurisdiction: FLORIDA
Filing Type: Domestic Profit

TAKASHI KOYAMA, DMD, PHD, PA is structured as a Domestic Profit Corporation, which, in Florida signifies a Profit Corporation (also known as a C-Corporation). This business structure is recognized as a separate legal entity from its owners. This offers shareholders the benefit of limited liability protection, safeguarding their personal assets from the corporation's debts and obligations, and facilitates raising capital through the issuance of stock. In Florida, Domestic Profit Corporations are governed by Title XXXVI, Chapter 607, Florida Statutes – Florida Business Corporation Act.
Status: Active

The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness.

Date Filed: 30 Mar 2006 (19 years ago)
Last Event: CANCEL ADM DISS/REV
Event Date Filed: 30 Jan 2009 (16 years ago)
Document Number: P06000045901
FEI/EIN Number 204626112

Federal Employer Identification (FEI) Number assigned by the IRS.
Address: 2402 FRIST BOULEVARD, 100, FORT PIERCE, FL, 34950
Mail Address: 12350 S.W. ELSINORE DRIVE, PORT ST. LUCIE, FL, 34987
ZIP code: 34950
County: St. Lucie
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1558429753 2006-12-04 2024-01-31 2402 FRIST BLVD STE 100, FORT PIERCE, FL, 349504838, US 2402 FRIST BLVD STE 100, FORT PIERCE, FL, 349504838, US

Contacts
Phone +1 772-461-9700
Fax 7724619300

Authorized person
Name TANYA GONZALEZ
Role PRACTICE MANAGER
Phone 7724619700

Taxonomy
Taxonomy Code 1223S0112X - Oral and Maxillofacial Surgery (Dentist)
Is Primary No
Taxonomy Code 204E00000X - Oral & Maxillofacial Surgery (D.M.D.)
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAL LICENSE
Number DN 16376
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
TAKASHI KOYAMA, DMD 401(K) SAVINGS PLAN 2023 204626112 2024-09-04 TAKASHI KOYAMA, DMD, PHD, PA 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621210
Sponsor’s telephone number 7724619700
Plan sponsor’s address 2402 FRIST BOULEVARD SUITE 100, FT PIERCE, FL, 34950

Signature of
Role Plan administrator
Date 2024-09-04
Name of individual signing LING LI
Valid signature Filed with authorized/valid electronic signature
TAKASHI KOYAMA, DMD 401(K) SAVINGS PLAN 2022 204626112 2023-09-05 TAKASHI KOYAMA, DMD, PHD, PA 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621210
Sponsor’s telephone number 7724619700
Plan sponsor’s address 2402 FRIST BOULEVARD SUITE 100, FT PIERCE, FL, 34950

Signature of
Role Plan administrator
Date 2023-09-05
Name of individual signing LING LI
Valid signature Filed with authorized/valid electronic signature
TAKASHI KOYAMA, DMD 401(K) SAVINGS PLAN 2021 204626112 2022-09-10 TAKASHI KOYAMA, DMD, PHD, PA 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621210
Sponsor’s telephone number 7724619700
Plan sponsor’s address 2402 FRIST BOULEVARD SUITE 100, FT PIERCE, FL, 34950

Signature of
Role Plan administrator
Date 2022-09-10
Name of individual signing LING LI
Valid signature Filed with authorized/valid electronic signature
TAKASHI KOYAMA, DMD 401(K) SAVINGS PLAN 2020 204626112 2021-10-06 TAKASHI KOYAMA, DMD, PHD, PA 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621210
Sponsor’s telephone number 7724619700
Plan sponsor’s address 2402 FRIST BOULEVARD SUITE 100, FT PIERCE, FL, 34950

Signature of
Role Plan administrator
Date 2021-10-06
Name of individual signing LING LI
Valid signature Filed with authorized/valid electronic signature
TAKASHI KOYAMA, DMD 401(K) SAVINGS PLAN 2019 204626112 2020-09-02 TAKASHI KOYAMA, DMD, PHD, PA 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621210
Sponsor’s telephone number 7724619700
Plan sponsor’s address 2402 FRIST BOULEVARD SUITE 100, FT PIERCE, FL, 34950

Signature of
Role Plan administrator
Date 2020-09-02
Name of individual signing LING LI
Valid signature Filed with authorized/valid electronic signature
TAKASHI KOYAMA, DMD 401(K) SAVINGS PLAN 2018 204626112 2019-09-10 TAKASHI KOYAMA, DMD, PHD, PA 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621210
Sponsor’s telephone number 7724619700
Plan sponsor’s address 2402 FRIST BOULEVARD SUITE 100, FT PIERCE, FL, 34950

Signature of
Role Plan administrator
Date 2019-09-10
Name of individual signing LING LI
Valid signature Filed with authorized/valid electronic signature
TAKASHI KOYAMA, DMD 401(K) SAVINGS PLAN 2017 204626112 2018-10-02 TAKASHI KOYAMA, DMD, PHD, PA 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621210
Sponsor’s telephone number 7724619700
Plan sponsor’s address 2402 FRIST BOULEVARD SUITE 100, FT PIERCE, FL, 34950

Signature of
Role Plan administrator
Date 2018-10-02
Name of individual signing LING LI
Valid signature Filed with authorized/valid electronic signature
TAKASHI KOYAMA, DMD 401(K) SAVINGS PLAN 2016 204626112 2017-08-01 TAKASHI KOYAMA,DMD,PHD,PA 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621210
Sponsor’s telephone number 7724619700
Plan sponsor’s address 2402 FRIST BOULEVARD SUITE 100, FT PIERCE, FL, 34950

Signature of
Role Plan administrator
Date 2017-08-01
Name of individual signing LING LI
Valid signature Filed with authorized/valid electronic signature
TAKASHI KOYAMA, DMD 401(K) SAVINGS PLAN 2015 204626112 2016-09-02 TAKASHI KOYAMA, DMD, PHD, PA 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621210
Sponsor’s telephone number 7724619700
Plan sponsor’s address 2402 FRIST BOULEVARD SUITE 100, FT PIERCE, FL, 34950

Signature of
Role Plan administrator
Date 2016-09-02
Name of individual signing LING LI
Valid signature Filed with authorized/valid electronic signature
TAKASHI KOYAMA, DMD 401(K) SAVINGS PLAN 2014 204626112 2015-09-02 TAKASHI KOYAMA, DMD, PHD, PA 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621210
Sponsor’s telephone number 7724619700
Plan sponsor’s address 2402 FRIST BOULEVARD SUITE 100, FT PIERCE, FL, 34950

Signature of
Role Plan administrator
Date 2015-09-02
Name of individual signing LING LI
Valid signature Filed with authorized/valid electronic signature

Key Officers & Management

Name Role Address
KOYAMA, DMD, PHD TAKASHI President 12350 S.W. ELSINORE DRIVE, PORT ST. LUCIE, FL, 34987
KOYAMA, DMD, PHD TAKASHI Vice President 12350 S.W. ELSINORE DRIVE, PORT ST. LUCIE, FL, 34987
KOYAMA, DMD, PHD TAKASHI Secretary 12350 S.W. ELSINORE DRIVE, PORT ST. LUCIE, FL, 34987
LI LING P Agent 12350 SW ELSINORE DRIVE, PORT SAINT LUCIE, FL, 34987

Events

Event Type Filed Date Value Description
REGISTERED AGENT NAME CHANGED 2010-02-17 LI, LING PH.D -
REGISTERED AGENT ADDRESS CHANGED 2010-02-17 12350 SW ELSINORE DRIVE, PORT SAINT LUCIE, FL 34987 -
CANCEL ADM DISS/REV 2009-01-30 - -
CHANGE OF PRINCIPAL ADDRESS 2009-01-30 2402 FRIST BOULEVARD, 100, FORT PIERCE, FL 34950 -
CHANGE OF MAILING ADDRESS 2009-01-30 2402 FRIST BOULEVARD, 100, FORT PIERCE, FL 34950 -
ADMIN DISSOLUTION FOR ANNUAL REPORT 2008-09-26 - -

Documents

Name Date
ANNUAL REPORT 2025-01-27
ANNUAL REPORT 2024-02-06
ANNUAL REPORT 2023-01-26
ANNUAL REPORT 2022-02-10
ANNUAL REPORT 2021-01-20
ANNUAL REPORT 2020-01-22
ANNUAL REPORT 2019-03-05
ANNUAL REPORT 2018-01-24
ANNUAL REPORT 2017-01-11
ANNUAL REPORT 2016-02-01

Companies related by officers

LI LING P

LIKOYAMA, LLC - Active
Florida Limited Liability Co. (2006 )

Companies related by address

No other companies in our directory share the same address as TAKASHI KOYAMA, DMD, PHD, PA

Date of last update: 01 Mar 2025

Sources: Florida Department of State

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