Provider Demographics
NPI:1679997035
Name:KOHANPOUR, ARASH
Entity Type:Individual
Prefix:
First Name:ARASH
Middle Name:
Last Name:KOHANPOUR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11727 W OLYMPIC BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-1202
Mailing Address - Country:US
Mailing Address - Phone:310-477-1073
Mailing Address - Fax:310-477-0498
Practice Address - Street 1:11727 W OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1202
Practice Address - Country:US
Practice Address - Phone:310-477-1073
Practice Address - Fax:310-477-0498
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55953183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist