Basic Information
Provider Information
NPI: 1134300601
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: COHEN
FirstName: SACHIKO
MiddleName: KINOSHITA
NamePrefix:  
NameSuffix:  
Credential: MFT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 11204 ASHER ST
Address2:  
City: EL MONTE
State: CA
PostalCode: 917313404
CountryCode: US
TelephoneNumber: 6269933000
FaxNumber:  
Practice Location
Address1: 11204 ASHER ST
Address2:  
City: EL MONTE
State: CA
PostalCode: 917313404
CountryCode: US
TelephoneNumber: 6269933000
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/26/2007
LastUpdateDate: 07/22/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106H00000XMFC42498CAY Behavioral Health & Social Service ProvidersMarriage & Family Therapist 

No ID Information.


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