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General NPI Number Information
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NPI Number | 1639463201
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Entity Type | Individual
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Provider Name | MR. THOMAS LOUIS KOFOED
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Gender | Male
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Dates
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Enumeration Date | 06/01/2011
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Last Update Date | 07/22/2014
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Provider Practice Location Address
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Address Line | 2500 WILSHIRE BLVD STE 704
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City | LOS ANGELES
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State | CA
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Zip | 90057-4312
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Country | US
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Telephone | 213-639-2661
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Fax | 213-389-1987
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Provider Business Mailing Address
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Address Line | 2500 WILSHIRE BLVD STE 704
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City | LOS ANGELES
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State | CA
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Zip | 90057-4312
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Country | US
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Telephone | 213-639-2661
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Fax | 213-389-1987
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State | CA
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