Healthcare Provider Details

I. General information

NPI: 1447193313
Provider Name (Legal Business Name): G KOHLI PROFESSIONAL DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16177 HESPERIAN BLVD STE A
SAN LORENZO CA
94580-2451
US

IV. Provider business mailing address

16177 HESPERIAN BLVD STE A
SAN LORENZO CA
94580-2451
US

V. Phone/Fax

Practice location:
  • Phone: 510-276-6930
  • Fax:
Mailing address:
  • Phone: 510-276-6930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GAGANDEEP KOHLI
Title or Position: PRESIDENT
Credential: DDS, MS
Phone: 510-276-6930