Basic Information
| Provider Information | |||||||||
| NPI: | 1801129663 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOHLI | ||||||||
| FirstName: | SANJIVAN | ||||||||
| MiddleName: | SINGH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7087 | ||||||||
| Address2: | |||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928637087 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145715000 | ||||||||
| FaxNumber: | 7145715055 | ||||||||
| Practice Location | |||||||||
| Address1: | 30230 RANCHO VIEJO RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SAN JUAN CAPISTRANO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926751557 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9494434303 | ||||||||
| FaxNumber: | 9494434033 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2009 | ||||||||
| LastUpdateDate: | 04/22/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | A109968 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
No ID Information.