Healthcare Provider Details

I. General information

NPI: 1356956460
Provider Name (Legal Business Name): KALI ANNE KOZIOL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2020
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2380 SUTTER ST FL 3
SAN FRANCISCO CA
94115-3006
US

IV. Provider business mailing address

2380 SUTTER ST FL 3
SAN FRANCISCO CA
94115-3006
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-2757
  • Fax: 415-353-2603
Mailing address:
  • Phone: 415-353-2757
  • Fax: 415-353-2603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number58148
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: