1184799892 NPI number — CHARLES RICHARD KOSSMAN M.D.

Table of content: MISS LAUREL L HOFFOWER (NPI 1457595076)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184799892 NPI number — CHARLES RICHARD KOSSMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOSSMAN
Provider First Name:
CHARLES
Provider Middle Name:
RICHARD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184799892
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3075 HEALTH CENTER DR
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92123-2773
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-637-7888
Provider Business Mailing Address Fax Number:
858-637-7887

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5555 RESERVOIR DR
Provider Second Line Business Practice Location Address:
SUITE 306
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92120-5134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-287-9910
Provider Business Practice Location Address Fax Number:
619-287-3526
Provider Enumeration Date:
11/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  G28857 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CN534Z . This is a "MEDICARE INDIVIDUAL PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1629046925 . This is a "MEDICAL ONCOLOGY ASSOCIATES OF SAN DIEGO NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: G28857 . This is a "CA LIC" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: AK7033171 . This is a "D.E.A" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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