Provider Demographics
NPI:1891103214
Name:KOHLI DDS INC
Entity Type:Organization
Organization Name:KOHLI DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GAGANDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-276-6930
Mailing Address - Street 1:16177 HESPERIAN BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN LORENZO
Mailing Address - State:CA
Mailing Address - Zip Code:94580-2451
Mailing Address - Country:US
Mailing Address - Phone:510-276-6930
Mailing Address - Fax:
Practice Address - Street 1:16177 HESPERIAN BLVD
Practice Address - Street 2:
Practice Address - City:SAN LORENZO
Practice Address - State:CA
Practice Address - Zip Code:94580-2451
Practice Address - Country:US
Practice Address - Phone:510-276-6930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-29
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA491241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1902963051OtherNPI