Provider Demographics
NPI:1952321564
Name:COSMER, KENNETH NILES (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:NILES
Last Name:COSMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:7230 MEDICAL CENTER DRIVE
Mailing Address - Street 2:402
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307
Mailing Address - Country:US
Mailing Address - Phone:818-340-3822
Mailing Address - Fax:818-340-8039
Practice Address - Street 1:7230 MEDICAL CENTER DRIVE
Practice Address - Street 2:402
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307
Practice Address - Country:US
Practice Address - Phone:818-340-3822
Practice Address - Fax:818-340-8039
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG57865208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics