Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 48712 | CA |
NPI | 1063556793 |
---|---|
Provider Name | Jason Michael Cohen |
First Address | San Jose, CA 95128-4812 |
Second Address | San Jose, CA 95128 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2007 |
Last Update Date | 13/12/2013 |