Healthcare Provider Details

I. General information

NPI: 1649364340
Provider Name (Legal Business Name): KATHY LEE COFFMAN MD, FAPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 10/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 W SUNSET BLVD STE 801
WEST HOLLYWOOD CA
90069-3709
US

IV. Provider business mailing address

9201 W SUNSET BLVD STE 801
WEST HOLLYWOOD CA
90069-3709
US

V. Phone/Fax

Practice location:
  • Phone: 310-278-4175
  • Fax: 310-278-4789
Mailing address:
  • Phone: 310-278-4175
  • Fax: 310-278-4789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG65927
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberG65927
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberG65927
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: