Provider Demographics
NPI:1598779605
Name:COHEN, JASON SETH (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:SETH
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 1:8700 BEVERLY BLVD
Mailing Address - Street 2:CS-OCC
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-1804
Mailing Address - Country:US
Mailing Address - Phone:310-652-3779
Mailing Address - Fax:310-659-9039
Practice Address - Street 1:8700 BEVERLY BLVD
Practice Address - Street 2:CS-OCC
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-1804
Practice Address - Country:US
Practice Address - Phone:310-652-3779
Practice Address - Fax:310-659-9039
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA714352086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A714350Medicaid
CAA71435AOtherMEDICARE PTAN
CA00A714350Medicaid
CAH33296Medicare UPIN