MEDICARE: DR. GAGANDEEP SINGH KOHLI D.D.S.

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	122300000X	Dentist	49124	CA

General Provider Information

NPI Number	:	1902963051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GAGANDEEP SINGH KOHLI D.D.S.

Provider Business Mailing Address
First Line	:	16177 HESPERIAN BLVD
Second Line	:
City	:	SAN LORENZO
State	:	CA
Zip	:	94580-2451
Country	:	US
Telephone Number	:	510-276-6930
Fax Number	:	510-276-1061

Provider Business Practice Location Address
First Line	:	16177 HESPERIAN BLVD
Second Line	:
City	:	SAN LORENZO
State	:	CA
Zip	:	94580-2451
Country	:	US
Telephone Number	:	510-276-6930
Fax Number	:	510-276-1061

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

Provider Enumeration Date	:	01/01/2007
Last Update Date	:	05/02/2016

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