Provider Demographics
NPI:1154753481
Name:COHEN, STACEY CHIN YING (DMD)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:CHIN YING
Last Name:COHEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8920 WILSHIRE BLVD STE 410
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2004
Mailing Address - Country:US
Mailing Address - Phone:310-652-2360
Mailing Address - Fax:
Practice Address - Street 1:8920 WILSHIRE BLVD STE 410
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2004
Practice Address - Country:US
Practice Address - Phone:310-652-2360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-09
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA626721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice