Healthcare Provider Details

I. General information

NPI: 1962821629
Provider Name (Legal Business Name): DAVID KOHANCHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2014
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 SAMARITAN DR
SAN JOSE CA
95124-3908
US

IV. Provider business mailing address

755 BLOSSOM HILL RD
LOS GATOS CA
95032-3502
US

V. Phone/Fax

Practice location:
  • Phone: 408-559-2011
  • Fax:
Mailing address:
  • Phone: 818-430-6441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number274745
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number159433
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: