=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710330998
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KOKABI PHARMACEUTICAL, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2016
-----------------------------------------------------
Last Update Date | 07/22/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 CAMPBELL AVE
-----------------------------------------------------
City | REDLANDS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92373-6831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-261-2320
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20144 WELLS DR
-----------------------------------------------------
City | WOODLAND HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91364-4728
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-261-2320
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | KAVEH KEVIN KOKABI
-----------------------------------------------------
Credential | PHARM.D
-----------------------------------------------------
Telephone | 818-261-2320
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RPH62158
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------