Healthcare Provider Details

I. General information

NPI: 1205899689
Provider Name (Legal Business Name): DONALD I KUZYK DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 04/23/2020
Certification Date: 04/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 SYCAMORE DR STE 109
SIMI VALLEY CA
93065-1208
US

IV. Provider business mailing address

2925 SYCAMORE DR SUITE 109
SIMI VALLEY CA
93065-1208
US

V. Phone/Fax

Practice location:
  • Phone: 805-584-3510
  • Fax: 805-584-9747
Mailing address:
  • Phone: 805-584-3510
  • Fax: 805-584-9747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP0504X
TaxonomyPublic Medicine Podiatrist
License NumberE3256
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberE3256
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License NumberE3256
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License NumberE3256
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE3256
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberE3256
License Number StateCA
# 7
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE3256
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: