Healthcare Provider Details

I. General information

NPI: 1457581332
Provider Name (Legal Business Name): KEITH COHN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2009
Last Update Date: 05/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 SAN MARCOS AVE
SAN FRANCISCO CA
94116-1945
US

IV. Provider business mailing address

230 SAN MARCOS AVE
SAN FRANCISCO CA
94116-1945
US

V. Phone/Fax

Practice location:
  • Phone: 415-564-1072
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberGFE7780
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: