Individual
CHARLES RICHARD KOSSMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5555 RESERVOIR DR, SUITE 306, SAN DIEGO, CA 92120-5134
(619) 287-9910
(619) 287-3526
Mailing address
3075 HEALTH CENTER DR, SUITE 102, SAN DIEGO, CA 92123-2773
(858) 637-7888
(858) 637-7887
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
G28857
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1629046925
MEDICAL ONCOLOGY ASSOCIATES OF SAN DIEGO NPI
CA
01
—
AK7033171
D.E.A
CA
01
—
CN534Z
MEDICARE INDIVIDUAL PTAN
CA
01
—
G28857
CA LIC
CA
Enumeration date
11/21/2006
Last updated
11/08/2012
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