Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 29399 | TX |
N | 1223D0001X | Dental Public Health | D10062 | OR |
NPI | 1558762401 |
---|---|
Provider Name | Dr. Richie Kohli |
First Address | Portland, OR 97201-4869 |
Second Address | Portland, OR 97201-4869 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2014 |
Last Update Date | 10/09/2014 |