1508187469 NPI number — WILLIAM B COHEN MD A MEDICAL CORP

Table of content: (NPI 1508187469)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508187469 NPI number — WILLIAM B COHEN MD A MEDICAL CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAM B COHEN MD A MEDICAL CORP
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:
1508187469
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
149 S BARRINGTON AVE
Provider Second Line Business Mailing Address:
NO. 806
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90049-3310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-887-0500
Provider Business Mailing Address Fax Number:
310-889-1912

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8733 BEVERLY BLVD
Provider Second Line Business Practice Location Address:
STE 310
Provider Business Practice Location Address City Name:
WEST HOLLYWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90048-1827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-887-0500
Provider Business Practice Location Address Fax Number:
310-889-1912
Provider Enumeration Date:
06/15/2010

Additional Information

Authorized Official

Authorized Official Last Name:
COHEN
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
B
Authorized Official Title or Position:
MD, PRESIDENT
Authorized Official Telephone Number:
310-887-0500

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X , with the licence number:  G20565 , 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)





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