Kohli Professional Dental Corporation

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

KOHLI PROFESSIONAL DENTAL CORPORATION

Practice address

2243 Mowry Ave Ste C
Fremont, CA 94538-1630

Phone

(510) 792-9084

Fax

(510) 792-9620

NPI assigned

Sep 20, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Gagandeep Kohli, DDS, MS

Title

President

Phone

(510) 792-9084

Specialties & licenses 1

Addresses

Other names 1

• Fremont Family Dental Group Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1695168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695168000000",
    "number": "1124806039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2243 MOWRY AVE STE C",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945381630",
            "telephone_number": "510-792-9084",
            "fax_number": "510-792-9620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2243 MOWRY AVE STE C",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945381630",
            "telephone_number": "510-792-9084",
            "fax_number": "510-792-9620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOHLI PROFESSIONAL DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-20",
        "last_updated": "2023-09-20",
        "certification_date": "2023-09-20",
        "status": "A",
        "authorized_official_last_name": "KOHLI",
        "authorized_official_first_name": "GAGANDEEP",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "510-792-9084",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fremont Family Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Yaroon Gebresilassie Kochito, FNP
• Darya Koczela
• Ashi Kodi
• Priscilla Koh
• Amena Kohgadai
• Janell Koide
• Kolala Ventures
• Vijay R Kolavennu, PH. D.
• William Kole-James
• Dustin Dimalanta Koliner, ATC

• Dental Clinic/Center in Fremont, CA
• Providers in Fremont, CA by specialty
• Dental Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.