Provider Demographics
NPI:1275038135
Name:KOZASKY, KRISTEN LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:LEE
Last Name:KOZASKY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8654 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-2919
Mailing Address - Country:US
Mailing Address - Phone:323-788-3993
Mailing Address - Fax:
Practice Address - Street 1:15901 HAWTHORNE BLVD STE 460
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-2657
Practice Address - Country:US
Practice Address - Phone:323-716-2761
Practice Address - Fax:323-203-0190
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-24
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34181111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor