Provider Demographics
NPI:1114972874
Name:COHEN, MITCHELL G (MD)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:G
Last Name:COHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20306 SPECTRUM
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3417
Mailing Address - Country:US
Mailing Address - Phone:949-350-6992
Mailing Address - Fax:949-607-8855
Practice Address - Street 1:20162 SW BIRCH ST STE 150
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-0791
Practice Address - Country:US
Practice Address - Phone:949-531-5653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2020-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG64294208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
F28488Medicare UPIN
G64294Medicare ID - Type Unspecified