Provider Demographics
NPI:1710074133
Name:KOGAN, MILTON L (MD, MPH)
Entity Type:Individual
Prefix:
First Name:MILTON
Middle Name:L
Last Name:KOGAN
Suffix:
Gender:M
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 1:5901 W OLYMPIC BLVD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-4667
Mailing Address - Country:US
Mailing Address - Phone:323-655-5068
Mailing Address - Fax:323-935-0996
Practice Address - Street 1:5901 W OLYMPIC BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4667
Practice Address - Country:US
Practice Address - Phone:323-655-5068
Practice Address - Fax:323-935-0996
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA28785207QA0505X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A287850Medicaid
CA00A287850Medicaid