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General NPI Number Information
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NPI Number | 1629398938
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Entity Type | Organization
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Legal Business Name | KOHLI PLASTIC SURGERY MEDICAL GROUP INC
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Dates
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Enumeration Date | 06/09/2010
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Last Update Date | 01/22/2012
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Provider Practice Location Address
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Address Line | 11100 WARNER AVE SUITE 206
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-7506
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Country | US
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Telephone | 949-954-8382
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Fax | 949-272-0430
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Provider Business Mailing Address
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Address Line | 15 PHOTINIA
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City | IRVINE
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State | CA
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Zip | 92620-2218
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Country | US
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Telephone | 949-954-8382
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Fax | 949-272-0430
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | DR. GURMANDER S. KOHLI
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Credential | MD
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Telephone | 949-954-8382
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | C51411
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License Number State | CA
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