Provider Demographics
NPI:1871646620
Name:KENNETH COHN, M.D., A MEDICAL CORPORATION
Entity type:Organization
Organization Name:KENNETH COHN, M.D., A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:COHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-567-1396
Mailing Address - Street 1:3849 TWEEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-6101
Mailing Address - Country:US
Mailing Address - Phone:323-567-1396
Mailing Address - Fax:323-567-4956
Practice Address - Street 1:3849 TWEEDY BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-6101
Practice Address - Country:US
Practice Address - Phone:323-567-1396
Practice Address - Fax:323-567-4956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG18784207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0100640Medicaid
CAG18784Medicare ID - Type Unspecified
CA0807520001Medicare NSC