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NPI Code Detail

MEDICARE: JOHN KOSTORYZ

MEDICARE: JOHN KOSTORYZ
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
1103TC0700XClinical Psychologist01191MO

General Provider Information

NPI Number : 1639256753
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN KOSTORYZ
Provider Business Mailing Address
First Line : 10117 FOREST AVE
Second Line :
City : KANSAS CITY
State : MO
Zip : 64131-3329
Country : US
Telephone Number : 816-333-0606
Fax Number : 816-523-5418
Provider Business Practice Location Address
First Line : 6155 OAK ST
Second Line : SUITE E
City : KANSAS CITY
State : MO
Zip : 64113-2238
Country : US
Telephone Number : 816-333-0606
Fax Number : 816-523-5418
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2006
Last Update Date : 03/15/2026

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