Provider Demographics
NPI:1801498597
Name:KOHAN, GEORGE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:KOHAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S DOHENY DR APT 420
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-2989
Mailing Address - Country:US
Mailing Address - Phone:310-770-0993
Mailing Address - Fax:
Practice Address - Street 1:12602 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2414
Practice Address - Country:US
Practice Address - Phone:818-762-2055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA71299183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist