Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | A94773 | CA |
Y | 208200000X | Surgeon | A94773 | CA |
Y | 208600000X | Surgeon | A94773 | CA |
NPI | 1396846721 |
---|---|
Provider Name | Dr. Kambiz Kosari |
First Address | Eagan, MN 55121-1447 |
Second Address | Van Nuys, CA 91405-4446 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 01/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A947730 | (05) | CA |
H83393 | (02) | CA |