Provider Demographics
NPI:1740438621
Name:JIM COSKUN MD PC
Entity type:Organization
Organization Name:JIM COSKUN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DERYA
Authorized Official - Middle Name:JIM
Authorized Official - Last Name:COSKUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-421-6741
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC532062084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty