MEDICARE: MR. DANNY MICHAEL KOSIM MFT

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	106H00000X	Marriage & Family Therapist	78335	CA

General Provider Information

NPI Number	:	1770619579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANNY MICHAEL KOSIM MFT

Provider Business Mailing Address
First Line	:	760 HARRISON ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94107-1235
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	814 HAMPSHIRE ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94110-2838
Country	:	US
Telephone Number	:	415-350-9412
Fax Number	:

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

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	10/07/2014

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