Provider Demographics
NPI:1417902974
Name:KOSSUTH, SARA L (DO)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:L
Last Name:KOSSUTH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2550 NORTH HOLLYWOOD WAY
Mailing Address - Street 2:SUITE 209
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-5019
Mailing Address - Country:US
Mailing Address - Phone:818-557-0135
Mailing Address - Fax:818-557-1394
Practice Address - Street 1:41870 GARSTIN DRIVE
Practice Address - Street 2:
Practice Address - City:BIG BEAR LAKE
Practice Address - State:CA
Practice Address - Zip Code:92315-1649
Practice Address - Country:US
Practice Address - Phone:909-878-8201
Practice Address - Fax:909-878-8286
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5955207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX59550Medicaid
CA020A59550OtherBLUE SHIELD
CA20A5955OtherBLUE CROSS
CA050618CF26282OtherBEAR VALLEY TRAILBLAZER
CA00AX59550Other20A5955
CAF26282Medicare UPIN
CA020A59550Medicare Oscar/Certification