1932501640 NPI number — K KOHANI D D S A PROFESSIONAL CORPORATION

Table of content: (NPI 1932501640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932501640 NPI number — K KOHANI D D S A PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
K KOHANI D D S A PROFESSIONAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COSTA VERDE DENTISTRY & ORTHODONIC
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932501640
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4510 EXECUTIVE DR
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92121-3021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-622-1007
Provider Business Mailing Address Fax Number:
858-622-1058

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4510 EXECUTIVE DR
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92121-3021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-622-1007
Provider Business Practice Location Address Fax Number:
858-622-1058
Provider Enumeration Date:
09/24/2014

Additional Information

Authorized Official

Authorized Official Last Name:
KOHANI
Authorized Official First Name:
KAMI
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
18586221007

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  39290 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1972710663 . This is a "MEDICARE NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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