Provider Demographics
NPI:1457885626
Name:KOUHKAN DPM CORPORATION
Entity Type:Organization
Organization Name:KOUHKAN DPM CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEHRNAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:KOUHKAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:310-347-5888
Mailing Address - Street 1:11690 MONTANA AVE
Mailing Address - Street 2:#105
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-4671
Mailing Address - Country:US
Mailing Address - Phone:310-347-5888
Mailing Address - Fax:
Practice Address - Street 1:23938 LYONS AVENUE
Practice Address - Street 2:STE 204
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-1240
Practice Address - Country:US
Practice Address - Phone:310-347-5888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-14
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5132213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty