Healthcare Provider Details

I. General information

NPI: 1073175139
Provider Name (Legal Business Name): LEONARDO KOZIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2019
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 COTTMAN AVE
PHILADELPHIA PA
19111-2497
US

IV. Provider business mailing address

333 COTTMAN AVE
PHILADELPHIA PA
19111-2497
US

V. Phone/Fax

Practice location:
  • Phone: 818-736-1605
  • Fax:
Mailing address:
  • Phone: 818-736-1605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT219459
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMD491223
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: