MEDICARE: SID KOHAN MD INCORPORATED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1194599860
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SID KOHAN MD INCORPORATED

Provider Business Mailing Address
First Line	:	821 N BUNDY DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-1506
Country	:	US
Telephone Number	:	818-618-9930
Fax Number	:

Provider Business Practice Location Address
First Line	:	821 N BUNDY DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-1506
Country	:	US
Telephone Number	:	818-618-9930
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICAL/ OWNER
Name	:	SID KOHAN
Credential	:	MD
Telephone Number	:	818-618-9930

Provider Enumeration Date	:	11/13/2023
Last Update Date	:	11/13/2023

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