Provider Demographics
NPI:1740521608
Name:KOGEN, FRED RAY (MD)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:RAY
Last Name:KOGEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1141
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-1141
Mailing Address - Country:US
Mailing Address - Phone:424-227-2797
Mailing Address - Fax:
Practice Address - Street 1:2230 W CHAPMAN AVE STE 209
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-2316
Practice Address - Country:US
Practice Address - Phone:626-556-7766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-01
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55365208100000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation