Healthcare Provider Details

I. General information

NPI: 1164165411
Provider Name (Legal Business Name): SAEEDEH KOWSARNIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4422 3RD AVE
BRONX NY
10457-2545
US

IV. Provider business mailing address

8508 JUMILLA AVE
WINNETKA CA
91306-1428
US

V. Phone/Fax

Practice location:
  • Phone: 718-960-6202
  • Fax:
Mailing address:
  • Phone: 857-361-2061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA127856300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: