Provider Demographics
NPI:1134891989
Name:KOUHKAN, JASMIN
Entity type:Individual
Prefix:
First Name:JASMIN
Middle Name:
Last Name:KOUHKAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17391 E SANTA CLARA AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-1865
Mailing Address - Country:US
Mailing Address - Phone:714-609-0282
Mailing Address - Fax:
Practice Address - Street 1:2526 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2607
Practice Address - Country:US
Practice Address - Phone:510-519-8041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-30
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program