MEDICARE: DR. MARK HAROLD KOGAN M.D.

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	207RG0100X	Gastroenterology Physician	G60809	CA

General Provider Information

NPI Number	:	1780690313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK HAROLD KOGAN M.D.

Provider Business Mailing Address
First Line	:	2089 VALE RD
Second Line	:	SUITE 33
City	:	SAN PABLO
State	:	CA
Zip	:	94806-3847
Country	:	US
Telephone Number	:	510-234-5012
Fax Number	:	510-234-4921

Provider Business Practice Location Address
First Line	:	2089 VALE RD
Second Line	:	SUITE 33
City	:	SAN PABLO
State	:	CA
Zip	:	94806-3847
Country	:	US
Telephone Number	:	510-234-5012
Fax Number	:	510-234-4921

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	03/11/2025

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