Provider Demographics
NPI:1689392078
Name:KOHANCHI, JOSHUA ARYA
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:ARYA
Last Name:KOHANCHI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 183
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91365-0183
Mailing Address - Country:US
Mailing Address - Phone:818-428-7037
Mailing Address - Fax:
Practice Address - Street 1:15211 VANOWEN ST STE 105
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-3614
Practice Address - Country:US
Practice Address - Phone:818-997-7711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-22
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA62189363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant