Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Revivamed Medical Corporation

Organization Internal Medicine Physician · NPI 1609061498

Revivamed Medical Corporation is an Internal Medicine Physician in San Diego, California. Licensed in California. Registered with an NPI since 2007.

Licensed in
CA
In the registry since
2007
Specialties on file
2

Practice location Address checks out

711 4th Ave Ste 200
San Diego, CA 92101-6970
Phone: (619) 232-3040
Fax: (619) 232-3041
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X · Licence A64593 (CA)
Plastic and Reconstructive Surgery Physician Taxonomy 2086S0122X · Licence A50365 (CA)

Record details

NPI number1609061498
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Roya Kohani — President · (619) 232-3040
NPI enumeratedSeptember 13, 2007
Last updated in NPPESSeptember 13, 2007
Mailing address711 4th Ave, Suite 200, San Diego, CA 92101-6970

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