Provider Demographics
NPI:1639412711
Name:KOHN, SEPIDEH A (LAC)
Entity Type:Individual
Prefix:MRS
First Name:SEPIDEH
Middle Name:A
Last Name:KOHN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 505
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5641
Mailing Address - Country:US
Mailing Address - Phone:310-666-0788
Mailing Address - Fax:
Practice Address - Street 1:2001 WILSHIRE BLVD
Practice Address - Street 2:SUITE 505
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5641
Practice Address - Country:US
Practice Address - Phone:310-666-0788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-27
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13998171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist