Provider Demographics
NPI:1649364340
Name:COFFMAN, KATHY LEE (MD, FAPM)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:LEE
Last Name:COFFMAN
Suffix:
Gender:F
Credentials:MD, FAPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9201 W SUNSET BLVD STE 801
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-3709
Mailing Address - Country:US
Mailing Address - Phone:310-278-4175
Mailing Address - Fax:310-278-4789
Practice Address - Street 1:9201 W SUNSET BLVD STE 801
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-3709
Practice Address - Country:US
Practice Address - Phone:310-278-4175
Practice Address - Fax:310-278-4789
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG659272084P0800X, 2084P0802X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE32591Medicare UPIN