Healthcare Provider Details

I. General information

NPI: 1073545968
Provider Name (Legal Business Name): WILLIAM CLAY COHEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 12/29/2023
Certification Date: 12/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 W LA VETA AVE STE 445
ORANGE CA
92868-4306
US

IV. Provider business mailing address

1010 W LA VETA AVE STE 445
ORANGE CA
92868-4306
US

V. Phone/Fax

Practice location:
  • Phone: 714-628-1313
  • Fax: 714-628-1319
Mailing address:
  • Phone: 714-628-1313
  • Fax: 714-628-1319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number20A6844
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: