MEDICARE: DR. FRED RAY KOGEN M.D.

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	208100000X	Physical Medicine & Rehabilitation Physician	G55365	CA
2	208D00000X	General Practice Physician	G55365	CA

General Provider Information

NPI Number	:	1740521608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FRED RAY KOGEN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1141
Second Line	:
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-1141
Country	:	US
Telephone Number	:	424-227-2797
Fax Number	:

Provider Business Practice Location Address
First Line	:	2230 W CHAPMAN AVE STE 209
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92868-2316
Country	:	US
Telephone Number	:	626-556-7766
Fax Number	:

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

Provider Enumeration Date	:	03/01/2013
Last Update Date	:	03/20/2024

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