Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | G11265 | CA |
Y | 111NI0900X | Internist | G11265 | CA |
N | 207RG0300X | Geriatric Medicine | G11265 | CA |
N | 207RN0300X | Nephrologist | G11265 | CA |
NPI | 1023020252 |
---|---|
Provider Name | David Cohen |
First Address | San Francisco, CA 94109-4853 |
Second Address | San Francisco, CA 94109-4853 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2006 |
Last Update Date | 21/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G112650 | (05) | CA |
05D0593596 | CLIA (01) | |
A38293 | (02) |