Provider Demographics
NPI:1720116502
Name:KOHUT, KAREN GELLER (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:GELLER
Last Name:KOHUT
Suffix:
Gender:F
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:PO BOX 1352
Mailing Address - Street 2:
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073-1352
Mailing Address - Country:US
Mailing Address - Phone:831-297-3236
Mailing Address - Fax:
Practice Address - Street 1:244 N JACKSON AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1604
Practice Address - Country:US
Practice Address - Phone:408-258-3724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81814174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G818140OtherMEDI-CAL
CABK3777010OtherDEA
CA20-3789068OtherTIN
CA00G818140OtherMEDI-CAL