Healthcare Provider Details

I. General information

NPI: 1770627259
Provider Name (Legal Business Name): DANIEL KOSOY MD FACS FRCSC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 11/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 FROST ST
SAN DIEGO CA
92123-2701
US

IV. Provider business mailing address

9889 GRADUATE DRIVEWAY STE 1-403
SAN DIEGO CA
92131-2510
US

V. Phone/Fax

Practice location:
  • Phone: 858-939-3400
  • Fax:
Mailing address:
  • Phone: 858-353-5561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License NumberA60375
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA60375
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: