Provider Demographics
NPI:1912223819
Name:PACIFIC ANESTHESIA GROUP
Entity Type:Organization
Organization Name:PACIFIC ANESTHESIA GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:FARSHAD
Authorized Official - Last Name:KOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-788-2400
Mailing Address - Street 1:PO BOX 241295
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-1295
Mailing Address - Country:US
Mailing Address - Phone:818-788-2400
Mailing Address - Fax:
Practice Address - Street 1:16260 VENTURA BLVD
Practice Address - Street 2:STE 800
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2203
Practice Address - Country:US
Practice Address - Phone:818-788-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-16
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical