Healthcare Provider Details

I. General information

NPI: 1467486407
Provider Name (Legal Business Name): KATHERINE OHANLAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 03/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4370 ALPINE RD SUITE 104
PORTOLA VALLEY CA
94028-7952
US

IV. Provider business mailing address

351 HOSPITAL RD SUITE 507
NEWPORT BEACH CA
92663-3509
US

V. Phone/Fax

Practice location:
  • Phone: 650-851-6669
  • Fax: 650-851-9747
Mailing address:
  • Phone: 949-642-1361
  • Fax: 949-642-1608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberG70108
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: