Provider Demographics
NPI:1447377296
Name:COHEN, KARMEN (DO)
Entity type:Individual
Prefix:
First Name:KARMEN
Middle Name:
Last Name:COHEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2492 WALNUT AVE
Mailing Address - Street 2:110
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-6953
Mailing Address - Country:US
Mailing Address - Phone:714-669-1997
Mailing Address - Fax:714-573-7424
Practice Address - Street 1:2492 WALNUT AVE
Practice Address - Street 2:110
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6953
Practice Address - Country:US
Practice Address - Phone:714-669-1997
Practice Address - Fax:714-573-7424
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA20A6122207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA20A6122OtherSTATE LIC#
CACA20A6122OtherSTATE LIC#