1326381591 NPI number — ROGER KOHN MD INC.

Table of content: (NPI 1326381591)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326381591 NPI number — ROGER KOHN MD INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROGER KOHN MD INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326381591
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1009 LAS PALMAS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA BARBARA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93110-2112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-682-9274
Provider Business Mailing Address Fax Number:
661-322-4304

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2920 F ST
Provider Second Line Business Practice Location Address:
SUITE C-17
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93301-1845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-322-5435
Provider Business Practice Location Address Fax Number:
661-322-4304
Provider Enumeration Date:
04/05/2013

Additional Information

Authorized Official

Authorized Official Last Name:
KOHN
Authorized Official First Name:
ROGER
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
805-682-9274

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  G31087 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5181222 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00G310870 . This is a "MEDICARE ID TYPE UNSPECIFIED/ NO. CALIFORNIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: G31087 . This is a "MEDICARE ID-TYPE UNSPECIFIED / SO. CALIFORNIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 8580218 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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