Provider Demographics
NPI:1477610087
Name:KOHN, JEAN GATEWOOD (MD, MPH)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:GATEWOOD
Last Name:KOHN
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BALDWIN AVE
Mailing Address - Street 2:#616
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3864
Mailing Address - Country:US
Mailing Address - Phone:650-342-2873
Mailing Address - Fax:
Practice Address - Street 1:750 WELCH RD
Practice Address - Street 2:RM 212
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1507
Practice Address - Country:US
Practice Address - Phone:650-723-5711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG2347261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG2347OtherMEDICAL LICENSE
CAG2347OtherMEDICAL LICENSE