MEDICARE: KAREN KOHATSU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	G70665	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	330322941	OTHER	CA	TRICARE
3	00G706650	OTHER	CA	BLUE SHIELD

General Provider Information

NPI Number	:	1679517239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN KOHATSU

Provider Business Mailing Address
First Line	:	11939 RANCHO BERNARDO RD
Second Line	:	SUITE 110
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-2073
Country	:	US
Telephone Number	:	858-613-8949
Fax Number	:	858-613-8953

Provider Business Practice Location Address
First Line	:	11939 RANCHO BERNARDO RD
Second Line	:	SUITE 110
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-2073
Country	:	US
Telephone Number	:	858-613-8949
Fax Number	:	858-613-8953

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	06/13/2008

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Directions to “ KAREN KOHATSU ” Practice Location

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