Provider Demographics
NPI:1710059894
Name:KOZINA, JOSEPH A (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:A
Last Name:KOZINA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:916-861-1486
Mailing Address - Fax:
Practice Address - Street 1:3941 J STREET
Practice Address - Street 2:SUITE 260
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3633
Practice Address - Country:US
Practice Address - Phone:916-736-2323
Practice Address - Fax:916-736-0620
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG57161207RC0000X, 207RC0001X, 207UN0901X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA060035632OtherRAILROAD MEDICARE
CA00G571610Medicaid
CAZZZ47673ZOtherBLUE SHIELD
CAZZZ47674ZOtherBLUE SHIELD
CAGR006823BMedicaid
CAGR0068232Medicaid
CAZZZ47676ZOtherBLUE SHIELD
CAGR0068230Medicaid
CAGR0068235Medicaid
CAZZZ62306ZOtherBLUE SHIELD
CAGR0068231Medicaid
CAGR0068233Medicaid
CAGR0068233Medicaid
E02808Medicare UPIN
CAGR006823BMedicaid
CAGR0068231Medicaid
CAZZZ00966ZMedicare PIN
CAZZZ47676ZOtherBLUE SHIELD
CA00G571610Medicare ID - Type Unspecified
CA00G571610Medicaid