MEDICARE: SOFIA NOOHANI KOHN PA-C

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	363A00000X	Physician Assistant	PA9107506	FL

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	:	1215363023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOFIA NOOHANI KOHN PA-C

Provider Business Mailing Address
First Line	:	5430 MILITARY TRL STE 64
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33458-2873
Country	:	US
Telephone Number	:	561-263-7010
Fax Number	:	561-776-3998

Provider Business Practice Location Address
First Line	:	5430 MILITARY TRL STE 64
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33458-2873
Country	:	US
Telephone Number	:	561-263-7010
Fax Number	:	561-776-3998

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

Provider Enumeration Date	:	09/25/2013
Last Update Date	:	04/02/2015

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