Healthcare Provider Details

I. General information

NPI: 1245655315
Provider Name (Legal Business Name): SEAN KOSSARI, M.D. A. PROF . CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2014
Last Update Date: 12/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14901 RINALDI ST STE 320
MISSION HILLS CA
91345-1255
US

IV. Provider business mailing address

14901 RINALDI ST STE 320
MISSION HILLS CA
91345-1255
US

V. Phone/Fax

Practice location:
  • Phone: 818-365-1616
  • Fax: 818-365-1811
Mailing address:
  • Phone: 818-365-1616
  • Fax: 818-365-1811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA68579
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA68579
License Number StateCA

VIII. Authorized Official

Name: SHAHRAM KOSSARI
Title or Position: PRESIDENT
Credential: MD
Phone: 818-365-1616