Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 35081935K | OH |
NPI | 1043315666 |
---|---|
Provider Name | Ann R Kooken |
First Address | Fairlawn, OH 44333-4510 |
Second Address | Fairlawn, OH 44333-4510 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 09/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2376414 | (05) | OH |
H80397 | (02) | OH |