Healthcare Provider Details

I. General information

NPI: 1275732372
Provider Name (Legal Business Name): KWABENA G OSEI MD,MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 11/08/2020
Certification Date: 11/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 E TACHEVAH DR STE 2E107
PALM SPRINGS CA
92262-5752
US

IV. Provider business mailing address

555 E TACHEVAH DR STE 2E107
PALM SPRINGS CA
92262-5752
US

V. Phone/Fax

Practice location:
  • Phone: 760-561-7373
  • Fax: 760-327-5140
Mailing address:
  • Phone: 760-561-7373
  • Fax: 760-327-5140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01067951A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC152209
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier200978970
Identifier TypeMEDICAID
Identifier StateIN
Identifier Issuer
# 2
Identifier000000079971
Identifier TypeOTHER
Identifier StateIN
Identifier IssuerBCBS MEMORIAL CHILDREN'S HOSPITAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: