Provider Demographics
NPI:1558625798
Name:KAMBIZ KOSARI MD INC
Entity type:Organization
Organization Name:KAMBIZ KOSARI MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAMBIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:855-521-6797
Mailing Address - Street 1:2854 HIGHWAY 55
Mailing Address - Street 2:SUITE 130
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-2156
Mailing Address - Country:US
Mailing Address - Phone:651-224-4930
Mailing Address - Fax:651-842-3391
Practice Address - Street 1:6850 SEPULVEDA BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-4446
Practice Address - Country:US
Practice Address - Phone:855-521-6797
Practice Address - Fax:888-472-9713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-03
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty