MEDICARE: DR. MARIO KOHAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	A348750	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184790305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIO KOHAN MD

Provider Business Mailing Address
First Line	:	PO BOX 10432
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90213-3432
Country	:	US
Telephone Number	:	213-637-2530
Fax Number	:	213-384-3373

Provider Business Practice Location Address
First Line	:	2208 W 7TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-4002
Country	:	US
Telephone Number	:	213-384-3434
Fax Number	:	213-386-2039

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	05/14/2010

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Directions to “ DR. MARIO KOHAN MD” Practice Location

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