Provider Demographics
NPI:1750800306
Name:G KOHLI DDS INC
Entity type:Organization
Organization Name:G KOHLI DDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GAGANDEEP
Authorized Official - Middle Name:S
Authorized Official - Last Name:KOHLI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:650-556-4778
Mailing Address - Street 1:2220 MOUNTAIN BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-2905
Mailing Address - Country:US
Mailing Address - Phone:510-482-5700
Mailing Address - Fax:510-482-0407
Practice Address - Street 1:2220 MOUNTAIN BLVD STE 206
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-2905
Practice Address - Country:US
Practice Address - Phone:510-482-5700
Practice Address - Fax:510-482-0407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49124261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental