MEDICARE: DR. CHLOE LEA COHEN D.D.S., M.S.

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	1223P0300X	Periodontics	61045	CA

General Provider Information

NPI Number	:	1912278417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHLOE LEA COHEN D.D.S., M.S.

Provider Business Mailing Address
First Line	:	655 S HOPE ST
Second Line	:	SUITE #1402
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-3237
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	655 S HOPE ST
Second Line	:	SUITE #1402
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-3237
Country	:	US
Telephone Number	:	310-435-3052
Fax Number	:	310-247-6369

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

Provider Enumeration Date	:	01/16/2012
Last Update Date	:	03/04/2014

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