Provider Demographics
NPI:1831260090
Name:KATOW, JEAN P
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:P
Last Name:KATOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 E 3RD ST
Mailing Address - Street 2:SUITE 603
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90013-1644
Mailing Address - Country:US
Mailing Address - Phone:213-680-1551
Mailing Address - Fax:213-680-2148
Practice Address - Street 1:420 E 3RD ST
Practice Address - Street 2:SUITE 603
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90013-1644
Practice Address - Country:US
Practice Address - Phone:213-680-1551
Practice Address - Fax:213-680-2148
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50632174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G506320Medicaid
CAGR0078582Medicaid
CAGR0078580Medicaid
CAGR0078581Medicaid
CA1710057245OtherGROUP NPI
CAGR0078583Medicaid
CAA92992Medicare UPIN
CAWG50632GMedicare ID - Type UnspecifiedINDIVIDUAL
CAW13961BMedicare ID - Type UnspecifiedGROUP NUMBER
CAW13961CMedicare ID - Type UnspecifiedGROUP NUMBER
CA1176620001Medicare NSC
CAW13961AMedicare ID - Type UnspecifiedGROUP NUMBER
CA00G506320Medicaid
CAGR0078583Medicaid
CAW13961Medicare ID - Type UnspecifiedGROUP NUMBER
CAWG50632DMedicare ID - Type UnspecifiedINDIVIDUAL
CAGR0078580Medicaid
CA1176620004Medicare NSC
CAWG50632FMedicare ID - Type UnspecifiedINDIVIDUAL