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General NPI Number Information
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NPI Number | 1750800306
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Entity Type | Organization
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Legal Business Name | G KOHLI DDS INC
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Dates
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Enumeration Date | 09/14/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2220 MOUNTAIN BLVD STE 206
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City | OAKLAND
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State | CA
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Zip | 94611-2905
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Country | US
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Telephone | 510-482-5700
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Fax | 510-482-0407
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Provider Business Mailing Address
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Address Line | 2220 MOUNTAIN BLVD STE 206
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City | OAKLAND
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State | CA
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Zip | 94611-2905
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Country | US
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Telephone | 510-482-5700
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Fax | 510-482-0407
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. GAGANDEEP S KOHLI
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Credential | DDS
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Telephone | 650-556-4778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 49124
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License Number State | CA
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