Healthcare Provider Details

I. General information

NPI: 1417036203
Provider Name (Legal Business Name): KIDNEY TRANSPLANT ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 04/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8631 W 3RD ST SUITE 615E
LOS ANGELES CA
90048-5901
US

IV. Provider business mailing address

8631 W 3RD ST SUITE 615E
LOS ANGELES CA
90048-5901
US

V. Phone/Fax

Practice location:
  • Phone: 310-652-8132
  • Fax: 310-659-3815
Mailing address:
  • Phone: 310-652-8132
  • Fax: 310-659-3815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: J LOUIS COHEN
Title or Position: PARTNER
Credential: M.D.
Phone: 310-652-8132