Provider Demographics
NPI:1225031586
Name:COHEN, STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
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 1:700 N TUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3602
Mailing Address - Country:US
Mailing Address - Phone:714-245-1444
Mailing Address - Fax:714-953-6604
Practice Address - Street 1:700 N TUSTIN AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3602
Practice Address - Country:US
Practice Address - Phone:714-245-1444
Practice Address - Fax:714-953-6604
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45078174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA060041549OtherRAILROAD MEDICARE
CAW13988OtherMEDICARE PTAN
CADB3373OtherRAILROAD MEDICARE
CAW13988AOtherMEDICARE PTAN
CAW13988OtherMEDICARE PTAN
CAWA45078EMedicare PIN
CAHW13988BMedicare PIN
CA060041549OtherRAILROAD MEDICARE