Individual
DR. GREGORY ERNEST KOCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
4081 STEPHENS ST, SAN DIEGO, CA 92103-1242
(888) 588-7836
(888) 588-7836
Mailing address
4081 STEPHENS ST, SAN DIEGO, CA 92103-1242
(888) 588-7836
(888) 588-7836
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
PSY19917
CA
103TB0200X
Cognitive & Behavioral Psychologist
PSY19917
CA
103TC0700X
Clinical Psychologist
PSY19917
CA
103TC2200X
Clinical Child & Adolescent Psychologist
PSY19917
CA
103TP2701X
Group Psychotherapy Psychologist
Primary
PSY19917
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0PL199170
BLUE SHIELD
CA
01
—
11397904
CAQH
CA
01
—
5551998
FIRSTHEALTH/CCN
CA
05
—
PSY199170
—
CA
Enumeration date
08/10/2005
Last updated
09/11/2025
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