Healthcare Provider Details

I. General information

NPI: 1679517239
Provider Name (Legal Business Name): KAREN KOHATSU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11939 RANCHO BERNARDO RD SUITE 110
SAN DIEGO CA
92128-2073
US

IV. Provider business mailing address

11939 RANCHO BERNARDO RD SUITE 110
SAN DIEGO CA
92128-2073
US

V. Phone/Fax

Practice location:
  • Phone: 858-613-8949
  • Fax: 858-613-8953
Mailing address:
  • Phone: 858-613-8949
  • Fax: 858-613-8953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG70665
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: