Provider Demographics
NPI:1972317766
Name:KOHLI, JIWANDEEP S (PHD)
Entity type:Individual
Prefix:
First Name:JIWANDEEP
Middle Name:S
Last Name:KOHLI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4573 TWAIN AVE APT 111
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-4126
Mailing Address - Country:US
Mailing Address - Phone:310-309-7468
Mailing Address - Fax:
Practice Address - Street 1:4573 TWAIN AVE APT 111
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-4126
Practice Address - Country:US
Practice Address - Phone:310-309-7468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35300103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical