Provider Demographics
NPI:1003326224
Name:DR. HOSS, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DR. HOSS, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:HOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-548-8772
Mailing Address - Street 1:9737 AERO DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1823
Mailing Address - Country:US
Mailing Address - Phone:619-591-2657
Mailing Address - Fax:
Practice Address - Street 1:11943 EL CAMINO REAL STE 200
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2597
Practice Address - Country:US
Practice Address - Phone:858-336-8478
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-02
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA410161223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty