Provider Demographics
NPI:1801841812
Name:KOHANIM, SHAHROKH
Entity Type:Individual
Prefix:DR
First Name:SHAHROKH
Middle Name:
Last Name:KOHANIM
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:SHAHROKH
Other - Middle Name:
Other - Last Name:KOHANIM APC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 661748
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91066-1748
Mailing Address - Country:US
Mailing Address - Phone:626-447-0296
Mailing Address - Fax:626-447-6057
Practice Address - Street 1:8491 W SUNSET BLVD
Practice Address - Street 2:#105
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-1911
Practice Address - Country:US
Practice Address - Phone:213-413-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7227207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX72270Medicaid
CA020A72270OtherBLUE SHIELD
CA020A72270OtherBLUE SHIELD
CAH03457Medicare UPIN
CA00AX72270Medicaid
CAW20A7227FMedicare PIN