Provider Demographics
NPI:1205322393
Name:KOHLI, HARJIVAN SINGH (MD)
Entity type:Individual
Prefix:DR
First Name:HARJIVAN
Middle Name:SINGH
Last Name:KOHLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 SAN JOAQUIN PLZ
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-5964
Mailing Address - Country:US
Mailing Address - Phone:619-519-9799
Mailing Address - Fax:
Practice Address - Street 1:301 W BASTANCHURY RD STE 180
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3427
Practice Address - Country:US
Practice Address - Phone:714-870-5970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA187272208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology