Healthcare Provider Details

I. General information

NPI: 1619881448
Provider Name (Legal Business Name): SIU L KOHITOLU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

499 LOMA ALTA AVE
LOS GATOS CA
95030-6227
US

IV. Provider business mailing address

10075 LEVONE AVE
TRUCKEE CA
96161-0443
US

V. Phone/Fax

Practice location:
  • Phone: 408-379-3790
  • Fax:
Mailing address:
  • Phone: 408-379-3790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number174400000X
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: