Provider Demographics
NPI:1215129184
Name:KOSEK, JENNIFER B (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:B
Last Name:KOSEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 BATH ST STE 208
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-5322
Mailing Address - Country:US
Mailing Address - Phone:805-682-7984
Mailing Address - Fax:
Practice Address - Street 1:2320 BATH ST STE 113
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4377
Practice Address - Country:US
Practice Address - Phone:805-682-7984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1074612085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1215129184Medicaid
CA0A1074610Medicaid
CA00A1074610OtherBS OF CA
CA00A1074610OtherBS OF CA
CAGC631YMedicare PIN
CAGC631ZMedicare PIN
CAGC631XMedicare PIN