Healthcare Provider Details

I. General information

NPI: 1063389963
Provider Name (Legal Business Name): CHRISTOPHER KOZLOWSKI, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2025
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 BERNARDO AVE STE 100
MOUNTAIN VIEW CA
94043-5139
US

IV. Provider business mailing address

189 BERNARDO AVE STE 100
MOUNTAIN VIEW CA
94043-5139
US

V. Phone/Fax

Practice location:
  • Phone: 615-474-3314
  • Fax:
Mailing address:
  • Phone: 615-474-3314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0404X
TaxonomyCardiac Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JEREMY EDWARD HAAG
Title or Position: CLINICAL OPERATIONS MANAGER
Credential: CRAT
Phone: 615-474-3314