Healthcare Provider Details

I. General information

NPI: 1790652410
Provider Name (Legal Business Name): EKATERINA (KATE) KOZLOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2025
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N BEDFORD DR STE 200
BEVERLY HILLS CA
90210-4306
US

IV. Provider business mailing address

404 S COCHRAN AVE APT 102
LOS ANGELES CA
90036-3387
US

V. Phone/Fax

Practice location:
  • Phone: 310-550-5566
  • Fax: 310-861-1164
Mailing address:
  • Phone: 310-550-5566
  • Fax: 310-861-1164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberL9881
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: