MEDICARE: G KOHLI PROFESSIONAL DENTAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1447193313
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	G KOHLI PROFESSIONAL DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	16177 HESPERIAN BLVD STE A
Second Line	:
City	:	SAN LORENZO
State	:	CA
Zip	:	94580-2451
Country	:	US
Telephone Number	:	510-276-6930
Fax Number	:

Provider Business Practice Location Address
First Line	:	16177 HESPERIAN BLVD STE A
Second Line	:
City	:	SAN LORENZO
State	:	CA
Zip	:	94580-2451
Country	:	US
Telephone Number	:	510-276-6930
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GAGANDEEP KOHLI
Credential	:	DDS, MS
Telephone Number	:	510-276-6930

Provider Enumeration Date	:	04/14/2026
Last Update Date	:	04/14/2026

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