Provider Demographics
NPI:1619957438
Name:KOHARI, JAMES TIMOTHY I (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:TIMOTHY
Last Name:KOHARI
Suffix:I
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:306 HOSPITAL DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SOUTH WILLIAMSON
Mailing Address - State:KY
Mailing Address - Zip Code:41503-4095
Mailing Address - Country:US
Mailing Address - Phone:606-237-0053
Mailing Address - Fax:606-237-6276
Practice Address - Street 1:306 HOSPITAL DR
Practice Address - Street 2:SUITE 105
Practice Address - City:SOUTH WILLIAMSON
Practice Address - State:KY
Practice Address - Zip Code:41503-4095
Practice Address - Country:US
Practice Address - Phone:606-237-0053
Practice Address - Fax:606-237-6276
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY02231207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYF13399Medicare UPIN