Provider Demographics
NPI:1245259258
Name:KOHUT PSYCHIATRIC MEDICAL GROUP INC
Entity type:Organization
Organization Name:KOHUT PSYCHIATRIC MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRY
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:KOHUT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-887-6222
Mailing Address - Street 1:1800 MEDICAL CENTER DRIVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92411
Mailing Address - Country:US
Mailing Address - Phone:909-887-6222
Mailing Address - Fax:909-887-4565
Practice Address - Street 1:1800 MEDICAL CENTER DRIVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92411
Practice Address - Country:US
Practice Address - Phone:909-887-6222
Practice Address - Fax:909-887-4565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ59319ZOtherBLUE SHIELD
CAGR0040560OtherMEDICAL
CAGR0040560OtherMEDICAL