Healthcare Provider Details

I. General information

NPI: 1831112259
Provider Name (Legal Business Name): ROYA KOHANI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 01/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 GIRARD AVE STE 101
LA JOLLA CA
92037-5138
US

IV. Provider business mailing address

7050 COUNTRY CLUB DR
LA JOLLA CA
92037-5609
US

V. Phone/Fax

Practice location:
  • Phone: 858-459-2040
  • Fax:
Mailing address:
  • Phone: 858-869-4455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA64593
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: