Provider Demographics
NPI:1689737439
Name:ASSOCIATED FAMILY PHYSICIANS
Entity Type:Organization
Organization Name:ASSOCIATED FAMILY PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:KOSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-689-4111
Mailing Address - Street 1:8110 TIMBERLAKE WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-5401
Mailing Address - Country:US
Mailing Address - Phone:916-689-4111
Mailing Address - Fax:916-689-6620
Practice Address - Street 1:8110 TIMBERLAKE WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-5401
Practice Address - Country:US
Practice Address - Phone:916-689-4111
Practice Address - Fax:916-689-6620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1710952122OtherNPI
1326153933OtherNPI
1942258744OtherNPI
CAE36951Medicare UPIN
P86059Medicare UPIN
1942258744OtherNPI
G22580Medicare UPIN
CAFG314ZMedicare PIN
1710952122OtherNPI
P69666Medicare UPIN
CA00A699680Medicare PIN
CA00G406700Medicare PIN