Healthcare Provider Details

I. General information

NPI: 1194760793
Provider Name (Legal Business Name): SHAHROKH KOHANIM A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 06/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8491 W SUNSET BLVD #105
WEST HOLLYWOOD CA
90069-1911
US

IV. Provider business mailing address

PO BOX 661748
ARCADIA CA
91066-1748
US

V. Phone/Fax

Practice location:
  • Phone: 323-913-4892
  • Fax:
Mailing address:
  • Phone: 626-447-0296
  • Fax: 626-447-6057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SHAHROKH KOHANIM
Title or Position: PRESIDENT
Credential:
Phone: 323-913-4892