Provider Demographics
NPI:1336240316
Name:KOHFELD, JEFFREY DEAN (PA)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DEAN
Last Name:KOHFELD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 E MCKELLIPS RD STE 105
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-9654
Mailing Address - Country:US
Mailing Address - Phone:602-491-0701
Mailing Address - Fax:480-631-0581
Practice Address - Street 1:72780 COUNTRY CLUB DR STE C300
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4150
Practice Address - Country:US
Practice Address - Phone:760-341-5550
Practice Address - Fax:833-471-2093
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16230363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMK0794758Medicaid
CAPA16230OtherCA LICENSE #
CA0PA162301Medicare PIN