Provider Demographics
NPI:1326061318
Name:COSKUN, DERYA JIM (MD)
Entity Type:Individual
Prefix:DR
First Name:DERYA
Middle Name:JIM
Last Name:COSKUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:750 MEDICAL CENTER CT
Mailing Address - Street 2:SUITE 13
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-6634
Mailing Address - Country:US
Mailing Address - Phone:619-421-6741
Mailing Address - Fax:619-421-3777
Practice Address - Street 1:750 MEDICAL CENTER CT
Practice Address - Street 2:SUITE 13
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-6634
Practice Address - Country:US
Practice Address - Phone:619-421-6741
Practice Address - Fax:619-421-3777
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0412592084N0400X
CAC532062084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H83408Medicare UPIN
CT130000594Medicare ID - Type Unspecified