Provider Demographics
NPI:1770627259
Name:KOSOY, DANIEL (MD FACS FRCSC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:KOSOY
Suffix:
Gender:M
Credentials:MD FACS FRCSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9889 GRADUATE DRIVEWAY STE 1-403
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-2510
Mailing Address - Country:US
Mailing Address - Phone:858-353-5561
Mailing Address - Fax:
Practice Address - Street 1:7901 FROST ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2701
Practice Address - Country:US
Practice Address - Phone:858-939-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2019-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60375204F00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACE226YOtherMEDICARE PTAN (BALBOA NEPHROLOGY MEDICAL GROUP)
CA867378Medicare UPIN
CACE226YOtherMEDICARE PTAN (BALBOA NEPHROLOGY MEDICAL GROUP)