1932438637 NPI number — CHARLES R. KOSSMAN, M.D., INC.

Table of content: (NPI 1932438637)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932438637 NPI number — CHARLES R. KOSSMAN, M.D., INC.

Organization/Personal Information

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

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:
1932438637
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/22/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5555 RESERVOIR DR
Provider Second Line Business Mailing Address:
#306
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92120-5134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-287-9910
Provider Business Mailing Address Fax Number:
619-287-3526

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5555 RESERVOIR DR
Provider Second Line Business Practice Location Address:
#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:
12/09/2009

Additional Information

Authorized Official

Authorized Official Last Name:
KOSSMAN
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
RICHARD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
619-287-9910

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: 1184799892 . This is a "MEDICARE INDIVIDUAL NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CN534Z . This is a "MEDICARE INDIVIDUAL PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CN538A . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com