1871525998 NPI number — ROY KOHL MD

Table of content: ROY KOHL MD (NPI 1871525998)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871525998 NPI number — ROY KOHL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOHL
Provider First Name:
ROY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1871525998
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/27/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1520 SAN PABLO ST
Provider Second Line Business Mailing Address:
SUITE 4300
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90033-5310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-442-5849
Provider Business Mailing Address Fax Number:
323-442-6798

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 CONGRESS ST
Provider Second Line Business Practice Location Address:
SUITE 504
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91105-3045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-442-5849
Provider Business Practice Location Address Fax Number:
323-442-6798
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  G17126 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X , with the licence number: G17126 , 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: 770002257 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00G171260F94 . This is a "CAL OPTIMA PIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00G171260C29 . This is a "CAL OPTIMA PIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00G171260 . This is a "BLUE SHIELD PIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00G171260 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00416526 . This is a "MEDICARE RAILROAD PIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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