Healthcare Provider Details

I. General information

NPI: 1396846721
Provider Name (Legal Business Name): KAMBIZ KOSARI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 S SAN VICENTE BLVD FL 7
LOS ANGELES CA
90048-3311
US

IV. Provider business mailing address

4140 W 190TH ST
TORRANCE CA
90504-5513
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-6746
  • Fax: 310-423-7596
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License NumberA94773
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA94773
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: