Healthcare Provider Details

I. General information

NPI: 1689737439
Provider Name (Legal Business Name): ASSOCIATED FAMILY PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 03/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8110 TIMBERLAKE WAY
SACRAMENTO CA
95823-5401
US

IV. Provider business mailing address

8110 TIMBERLAKE WAY
SACRAMENTO CA
95823-5401
US

V. Phone/Fax

Practice location:
  • Phone: 916-689-4111
  • Fax: 916-689-6620
Mailing address:
  • Phone: 916-689-4111
  • Fax: 916-689-6620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID L KOSH
Title or Position: OWNER
Credential: M.D
Phone: 916-689-4111