Healthcare Provider Details

I. General information

NPI: 1740521608
Provider Name (Legal Business Name): FRED RAY KOGEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2013
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 W CHAPMAN AVE STE 209
ORANGE CA
92868-2316
US

IV. Provider business mailing address

PO BOX 1141
LOS ALAMITOS CA
90720-1141
US

V. Phone/Fax

Practice location:
  • Phone: 626-556-7766
  • Fax:
Mailing address:
  • Phone: 424-227-2797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberG55365
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberG55365
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: