Provider Demographics
NPI:1528846920
Name:KOSSEH, JIM B
Entity type:Individual
Prefix:
First Name:JIM
Middle Name:B
Last Name:KOSSEH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JIM
Other - Middle Name:
Other - Last Name:KOSSEH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:873 N MEADOWS CT APT F
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-3242
Mailing Address - Country:US
Mailing Address - Phone:347-247-2349
Mailing Address - Fax:
Practice Address - Street 1:873 N MEADOWS CT APT F
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-3242
Practice Address - Country:US
Practice Address - Phone:347-247-2349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHUG675328347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle