Healthcare Provider Details

I. General information

NPI: 1174713366
Provider Name (Legal Business Name): MICHAEL N. KOSS, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 07/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 OCEAN VIEW AVE SUITE 212
LOS ANGELES CA
90057-2757
US

IV. Provider business mailing address

1310 FAIRLAWN WAY
PASADENA CA
91105-1014
US

V. Phone/Fax

Practice location:
  • Phone: 213-381-2260
  • Fax:
Mailing address:
  • Phone: 626-304-0740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberG40559
License Number StateCA

VIII. Authorized Official

Name: MICHAEL N. KOSS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 626-304-0740