Healthcare Provider Details

I. General information

NPI: 1952633323
Provider Name (Legal Business Name): JAMES JACK KOHAN MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2010
Last Update Date: 10/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2658 DEL MAR HEIGHTS RD #358
DEL MAR CA
92014-3100
US

IV. Provider business mailing address

PO BOX 700309
KAPOLEI HI
96709-0309
US

V. Phone/Fax

Practice location:
  • Phone: 808-352-2501
  • Fax: 858-755-3758
Mailing address:
  • Phone: 808-203-7943
  • Fax: 808-693-8060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD13365
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberMD13365
License Number StateHI

VIII. Authorized Official

Name: DR. JAMES MICHAEL KOHAN
Title or Position: PRESIDENT
Credential: MD
Phone: 808-352-2501