MEDICARE: JAMES JACK KOHAN MD LLC

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	207RS0012X	Sleep Medicine (Internal Medicine) Physician	MD13365	HI
2	207RP1001X	Pulmonary Disease Physician	MD13365	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0000291385	OTHER	HI	HMSA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952633323
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES JACK KOHAN MD LLC

Provider Business Mailing Address
First Line	:	PO BOX 700309
Second Line	:
City	:	KAPOLEI
State	:	HI
Zip	:	96709-0309
Country	:	US
Telephone Number	:	808-203-7943
Fax Number	:	808-693-8060

Provider Business Practice Location Address
First Line	:	2658 DEL MAR HEIGHTS RD
Second Line	:	#358
City	:	DEL MAR
State	:	CA
Zip	:	92014-3100
Country	:	US
Telephone Number	:	808-352-2501
Fax Number	:	858-755-3758

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAMES MICHAEL KOHAN
Credential	:	MD
Telephone Number	:	808-352-2501

Provider Enumeration Date	:	02/09/2010
Last Update Date	:	10/17/2012

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