Provider Demographics
NPI:1326381591
Name:ROGER KOHN MD INC.
Entity Type:Organization
Organization Name:ROGER KOHN MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-682-9274
Mailing Address - Street 1:1009 LAS PALMAS DR
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93110-2112
Mailing Address - Country:US
Mailing Address - Phone:805-682-9274
Mailing Address - Fax:661-322-4304
Practice Address - Street 1:2920 F ST
Practice Address - Street 2:SUITE C-17
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-1845
Practice Address - Country:US
Practice Address - Phone:661-322-5435
Practice Address - Fax:661-322-4304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-05
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG31087174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5181222Medicaid
CA00G310870OtherMEDICARE ID TYPE UNSPECIFIED/ NO. CALIFORNIA
CAG31087OtherMEDICARE ID-TYPE UNSPECIFIED / SO. CALIFORNIA
CA8580218Medicaid
CA00G310870OtherMEDICARE ID TYPE UNSPECIFIED/ NO. CALIFORNIA