Healthcare Provider Details

I. General information

NPI: 1609021849
Provider Name (Legal Business Name): ELIANA L KOZIN BCH BAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2008
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8010 FROST ST STE 300
SAN DIEGO CA
92123-4221
US

IV. Provider business mailing address

8010 FROST ST STE 300
SAN DIEGO CA
92123-4221
US

V. Phone/Fax

Practice location:
  • Phone: 858-692-6622
  • Fax:
Mailing address:
  • Phone: 858-939-6622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberC172120
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: