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Organization
KOHUT PSYCHIATRIC MEDICAL GROUP INC
Active
Organization
KOHUT PSYCHIATRIC MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN JOEL KOHUT MD (PSYCHIATRY)
(909) 887-6222
Entity
Organization
Contact information
Practice address
1800 MEDICAL CENTER DRIVE, SUITE 300, SAN BERNARDINO, CA 92411
(909) 887-6222
(909) 887-4565
Mailing address
1800 MEDICAL CENTER DRIVE, SUITE 300, SAN BERNARDINO, CA 92411
(909) 887-6222
(909) 887-4565
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GR0040560
MEDICAL
CA
01
—
ZZZ59319Z
BLUE SHIELD
—
Enumeration date
07/19/2006
Last updated
06/22/2017
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