Provider Demographics
NPI:1831356708
Name:KOGAN, GREGORY ALEXANDER (DO)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:ALEXANDER
Last Name:KOGAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2923 BRADLEY ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-1502
Mailing Address - Country:US
Mailing Address - Phone:626-795-6596
Mailing Address - Fax:
Practice Address - Street 1:2923 BRADLEY ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-1502
Practice Address - Country:US
Practice Address - Phone:626-795-6596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A 9419207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU860YMedicare PIN
CAW20A9419AMedicare PIN