Provider Demographics
NPI:1417930603
Name:KOSSUTH, SARA RACHAEL (DO)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:RACHAEL
Last Name:KOSSUTH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6520 PLATT AVENUE
Mailing Address - Street 2:SUITE 513
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307
Mailing Address - Country:US
Mailing Address - Phone:310-490-7759
Mailing Address - Fax:818-887-2285
Practice Address - Street 1:6520 PLATT AVENUE
Practice Address - Street 2:SUITE 513
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307
Practice Address - Country:US
Practice Address - Phone:310-490-7759
Practice Address - Fax:818-887-2285
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8025207R00000X, 207RC0200X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18555OtherMEDICARE GROUP NUMBER
CAW18555OtherMEDICARE GROUP NUMBER
CAI26453Medicare UPIN