1376670273 NPI number — DR. ROGER A KOHN

Table of content: DR. ROGER A KOHN (NPI 1376670273)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376670273 NPI number — DR. ROGER A KOHN

Organization/Personal Information

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

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:
1376670273
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
525 E MICHELTORENA ST
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
SANTA BARBARA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93103-2254
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-682-9274
Provider Business Mailing Address Fax Number:
805-962-4716

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:
02/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

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: 8580218 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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