Healthcare Provider Details

I. General information

NPI: 1396447579
Provider Name (Legal Business Name): TATIANA KOZIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 EDWARDS RD STE 350
CINCINNATI OH
45209-1940
US

IV. Provider business mailing address

3805 EDWARDS RD STE 350
CINCINNATI OH
45209-1940
US

V. Phone/Fax

Practice location:
  • Phone: 513-871-7848
  • Fax: 513-871-3278
Mailing address:
  • Phone: 513-871-7848
  • Fax: 513-871-3278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.157001
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: