Healthcare Provider Details

I. General information

NPI: 1407987498
Provider Name (Legal Business Name): SARA R KOSSUTH DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 06/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 BEVERLY BLVD
LOS ANGELES CA
90048-1804
US

IV. Provider business mailing address

6520 PLATT AVENUE SUITE 513
WEST HILLS CA
91307
US

V. Phone/Fax

Practice location:
  • Phone: 310-490-7759
  • Fax: 818-887-2285
Mailing address:
  • Phone: 310-490-7759
  • Fax: 818-887-2285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A8025
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number20A8025
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number20A8025
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number20A8025
License Number StateCA

VIII. Authorized Official

Name: DR. SARA RACHAEL KOSSUTH
Title or Position: PRESIDENT
Credential: DO
Phone: 310-490-7759