MEDICARE: KAREN E. KOHATSU, M.D., INC.

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	174400000X	Specialist	G70665	CA

General Provider Information

NPI Number	:	1851432165
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAREN E. KOHATSU, M.D., INC.

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	:	PRESIDENT
Name	:	DR. KAREN E KOHATSU
Credential	:	M.D.
Telephone Number	:	858-613-8949

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	06/16/2008

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