MEDICARE: SHAHROKH KOHANIM A PROFESSIONAL CORPORATION

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	207P00000X	Emergency Medicine Physician

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	:	1194760793
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHAHROKH KOHANIM A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 661748
Second Line	:
City	:	ARCADIA
State	:	CA
Zip	:	91066-1748
Country	:	US
Telephone Number	:	626-447-0296
Fax Number	:	626-447-6057

Provider Business Practice Location Address
First Line	:	8491 W SUNSET BLVD
Second Line	:	#105
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90069-1911
Country	:	US
Telephone Number	:	323-913-4892
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SHAHROKH KOHANIM
Credential	:
Telephone Number	:	323-913-4892

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	06/27/2014

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