MEDICARE: DR. DANIEL D KOHANCHI DDS

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	390200000X	Student in an Organized Health Care Education/Training Program
2	1223D0004X	Dental Anesthesiology	103859	CA

General Provider Information

NPI Number	:	1841858420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL D KOHANCHI DDS

Provider Business Mailing Address
First Line	:	5669 SLOAN PL
Second Line	:
City	:	CALABASAS
State	:	CA
Zip	:	91302-3159
Country	:	US
Telephone Number	:	818-621-8317
Fax Number	:

Provider Business Practice Location Address
First Line	:	5669 SLOAN PL
Second Line	:
City	:	CALABASAS
State	:	CA
Zip	:	91302-3159
Country	:	US
Telephone Number	:	818-621-8317
Fax Number	:

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

Provider Enumeration Date	:	05/30/2019
Last Update Date	:	09/04/2022

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