Revivamed Medical Corporation

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

A64593 Issued in CA

Legal business name

REVIVAMED MEDICAL CORPORATION

Practice address

711 4TH Ave
Suite 200
San Diego, CA 92101-6970

Phone

(619) 232-3040

Fax

(619) 232-3041

NPI assigned

Sep 13, 2007

Last updated

Sep 13, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Roya Kohani, M.D.NPI 1831112259

Title

President

Phone

(619) 232-3040

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kian J Samimi, MD

  • Plastic Surgery Physician
  • San Diego, CA
  • NPI 1649213281
  Medicare reassignment NPD
• Roya Kohani, M.D.

  • Internal Medicine Physician
  • La Jolla, CA
  • NPI 1831112259
  NPD (past) Authorized official
• Jenny Marie Hullinger, RN

  • Plastic and Reconstructive Surgery Physician
  • San Diego, CA
  • NPI 1598245474
  NPD (past)
• Amanda McGee, RN

  • Plastic and Reconstructive Surgery Physician
  • San Diego, CA
  • NPI 1962982850
  NPD (past)

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

{
    "created_epoch": "1189641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189641600000",
    "number": "1609061498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 4TH AVE",
            "address_2": "SUITE 200",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921016970",
            "telephone_number": "619-232-3040",
            "fax_number": "619-232-3041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 4TH AVE",
            "address_2": "SUITE 200",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921016970",
            "telephone_number": "619-232-3040",
            "fax_number": "619-232-3041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVAMED MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-13",
        "last_updated": "2007-09-13",
        "status": "A",
        "authorized_official_last_name": "KOHANI",
        "authorized_official_first_name": "ROYA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "619-232-3040",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A64593",
            "primary": true
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "CA",
            "license": "A50365",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shanae Revell
• Thomas Revell
• Chrystine Rae Revelli, FNP-C
• Janet Mary Revels, PMHNP
• Revival DME Corp
• Revive Medical of San Diego
• Revive Medspa
• Revive Psychiatric Center (Revive Psychiatric and Psychological Center)
• Revive Salon and Spa
• George Albert Rew, CERTIFICATION

• Internal Medicine Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.