Centerline Diagnostics

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

A109968 Issued in CA

Legal business name

CENTERLINE DIAGNOSTICS

Practice address

154 W Foothill Blvd
Suite#518
Upland, CA 91786-8702

Phone

(310) 954-9511

Fax

(310) 817-6364

NPI assigned

May 13, 2015

Organization subpart

No

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

Authorized official

Name

Sanjivan Singh Kohli, MD

Title

Owner

Phone

(310) 954-9511

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1431475200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431475200000",
    "number": "1992183602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "154 W FOOTHILL BLVD",
            "address_2": "SUITE#518",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917868702",
            "telephone_number": "310-954-9511",
            "fax_number": "310-817-6364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "154 W FOOTHILL BLVD",
            "address_2": "SUITE#518",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917868702",
            "telephone_number": "310-954-9511",
            "fax_number": "310-817-6364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTERLINE DIAGNOSTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-13",
        "last_updated": "2015-05-13",
        "status": "A",
        "authorized_official_last_name": "KOHLI",
        "authorized_official_first_name": "SANJIVAN",
        "authorized_official_middle_name": "SINGH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "310-954-9511",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A109968",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Upland, CA
• Providers in Upland, 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 May 13, 2015; 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.