Healthcare Provider Details

I. General information

NPI: 1053870832
Provider Name (Legal Business Name): KAITLIN KOGACHI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 PACIFIC COAST HWY
HARBOR CITY CA
90710-3509
US

IV. Provider business mailing address

1050 PACIFIC COAST HWY FL 1
HARBOR CITY CA
90710-3509
US

V. Phone/Fax

Practice location:
  • Phone: 310-602-7940
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA187825
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberPG212223
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: