Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 12084 | MI |
NPI | 1003859760 |
---|---|
Provider Name | Dr. Jerry Kohen |
First Address | Oakbrook Terrace, IL 60181-5249 |
Second Address | Hines, IL 60141 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2006 |
Last Update Date | 08/07/2007 |