Healthcare Provider Details

I. General information

NPI: 1871381996
Provider Name (Legal Business Name): DR. JOHN SAMUEL COUKOS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 BERRY ST STE 100
SAN FRANCISCO CA
94107-1758
US

IV. Provider business mailing address

1101 E 56TH ST # C403
CHICAGO IL
60637-1510
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-1667
  • Fax:
Mailing address:
  • Phone: 774-279-4565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: