Healthcare Provider Details

I. General information

NPI: 1043698434
Provider Name (Legal Business Name): VIVEK KUMAR KOHLI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2015
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 PARK BEND DR STE 300
AUSTIN TX
78758-5386
US

IV. Provider business mailing address

2200 PARK BEND DR. BLDG 2, STE. 300
AUSTIN TX
78758
US

V. Phone/Fax

Practice location:
  • Phone: 512-836-5665
  • Fax: 512-997-9092
Mailing address:
  • Phone: 512-836-5665
  • Fax: 512-997-9092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR7251
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: