MEDICARE: DR. JAMES J KOZAK D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	30086	CA

General Provider Information

NPI Number	:	1275684706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES J KOZAK D.D.S.

Provider Business Mailing Address
First Line	:	8685 LA MESA BLVD # F
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91941-3903
Country	:	US
Telephone Number	:	619-463-0393
Fax Number	:	619-463-8346

Provider Business Practice Location Address
First Line	:	8685 LA MESA BLVD # F
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91941-3903
Country	:	US
Telephone Number	:	619-463-0393
Fax Number	:	619-463-8346

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	06/05/2008

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