Provider Demographics
NPI:1194599860
Name:SID KOHAN MD INCORPORATED
Entity type:Organization
Organization Name:SID KOHAN MD INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICAL/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SID
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-618-9930
Mailing Address - Street 1:821 N BUNDY DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-1506
Mailing Address - Country:US
Mailing Address - Phone:818-618-9930
Mailing Address - Fax:
Practice Address - Street 1:821 N BUNDY DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-1506
Practice Address - Country:US
Practice Address - Phone:818-618-9930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty