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General NPI Number Information
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NPI Number | 1336315274
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Entity Type | Individual
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Provider Name | RICHARD ALAN KOHN DDS MS
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Gender | Male
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Dates
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Enumeration Date | 04/30/2008
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Last Update Date | 04/30/2008
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Provider Practice Location Address
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Address Line | 475 W 55TH ST SUITE 208
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City | COUNTRYSIDE
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State | IL
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Zip | 60525-3564
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Country | US
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Telephone | 708-579-0488
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Fax | 708-579-0611
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Provider Business Mailing Address
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Address Line | 475 W 55TH ST SUITE 208
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City | COUNTRYSIDE
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State | IL
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Zip | 60525-3564
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Country | US
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Telephone | 708-579-0488
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Fax | 708-579-0611
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 021-001106
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License Number State | IL
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