Healthcare Provider Details

I. General information

NPI: 1578620464
Provider Name (Legal Business Name): ORI KOCHAVI PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 12/30/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 TRAEGER AVE STE 209 KAISER - DEPT. OF CHILD & ADOLESCENT PSYCHIATRY
SAN BRUNO CA
94066-3048
US

IV. Provider business mailing address

1200 EL CAMINO REAL KAISER - DEPT. OF CHILD & ADOLESCENT PSYCHIATRY
SOUTH SAN FRANCISCO CA
94080-3208
US

V. Phone/Fax

Practice location:
  • Phone: 650-742-2737
  • Fax: 650-742-7135
Mailing address:
  • Phone: 650-742-2737
  • Fax: 650-742-7135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY16411
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: