Provider Demographics
NPI:1659621787
Name:FREDERICK M KOHN MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:FREDERICK M KOHN MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-344-0960
Mailing Address - Street 1:5525 ETIWANDA AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3647
Mailing Address - Country:US
Mailing Address - Phone:818-344-0960
Mailing Address - Fax:818-344-3587
Practice Address - Street 1:5525 ETIWANDA AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3647
Practice Address - Country:US
Practice Address - Phone:818-344-0960
Practice Address - Fax:818-344-3587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG071991207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF26225Medicare UPIN