Healthcare Provider Details

I. General information

NPI: 1932736071
Provider Name (Legal Business Name): JACOB LOUIS COHEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 PARK TER STE 500
LOS ANGELES CA
90045-9212
US

IV. Provider business mailing address

1595 SHELTER COVE DR
FLEMING ISLAND FL
32003-7221
US

V. Phone/Fax

Practice location:
  • Phone: 904-505-5285
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberA201457
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: