Provider Demographics
NPI:1457613119
Name:COHEN, DAVID (DO)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:COHEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13955 TAHITI WAY
Mailing Address - Street 2:365
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6591
Mailing Address - Country:US
Mailing Address - Phone:818-746-6352
Mailing Address - Fax:
Practice Address - Street 1:21263 ERWIN ST
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-3715
Practice Address - Country:US
Practice Address - Phone:818-746-6352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-08
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ006134207P00000X
390200000X
CA20A 12981207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A12981OtherCALIFORNIA OSTEOPATHIC PHYSICIAN AND SURGEON MEDICAL LICENSE