Healthcare Provider Details

I. General information

NPI: 1871518621
Provider Name (Legal Business Name): KEITH KOHATSU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 09/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 TUNNEL RD
ASHEVILLE NC
28805-2043
US

IV. Provider business mailing address

1100 TUNNEL RD
ASHEVILLE NC
28805-2043
US

V. Phone/Fax

Practice location:
  • Phone: 828-298-7911
  • Fax:
Mailing address:
  • Phone: 828-298-7911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG79229
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: