Healthcare Provider Details

I. General information

NPI: 1093386203
Provider Name (Legal Business Name): DANE MARCUS KEAHI KOHLER NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2021
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 4TH ST FL 6
SAN FRANCISCO CA
94143-2351
US

IV. Provider business mailing address

27315 BAVELLA WAY
SALINAS CA
93908-1584
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-3831
  • Fax:
Mailing address:
  • Phone: 408-781-4234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP95015840
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: