Healthcare Provider Details

I. General information

NPI: 1457094799
Provider Name (Legal Business Name): KATIE MARKS COGAN MD INC A CALIFORNIA PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3831 HUGHES AVE STE 600A
CULVER CITY CA
90232-6843
US

IV. Provider business mailing address

2148 HILLSBORO AVE
LOS ANGELES CA
90034-1121
US

V. Phone/Fax

Practice location:
  • Phone: 424-603-4544
  • Fax: 424-603-4546
Mailing address:
  • Phone: 443-610-3059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KATIE MARKS
Title or Position: SHAREHOLDER
Credential: MD
Phone: 443-610-3059