Basic Information
| Provider Information | |||||||||
| NPI: | 1770627259 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOSOY | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD FACS FRCSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9889 GRADUATE DRIVEWAY STE 1-403 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921312510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8583535561 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7901 FROST ST | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921232701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8589393400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2007 | ||||||||
| LastUpdateDate: | 11/24/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 204F00000X | A60375 | CA | N | Allopathic & Osteopathic Physicians | Transplant Surgery | 208600000X | A60375 | CA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | CE226Y | 01 | CA | MEDICARE PTAN (BALBOA NEPHROLOGY MEDICAL GROUP) | OTHER |