Healthcare Provider Details

I. General information

NPI: 1679862502
Provider Name (Legal Business Name): DAVID SAMUEL COHEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2011
Last Update Date: 12/01/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

393 E WALNUT ST 3RD FLOOR
PASADENA CA
91188-0001
US

IV. Provider business mailing address

393 E WALNUT ST 3RD FLOOR
PASADENA CA
91188-0001
US

V. Phone/Fax

Practice location:
  • Phone: 310-919-8763
  • Fax:
Mailing address:
  • Phone: 310-919-8763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA143194
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: