Kyle L Koski, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

3392 Issued in AZ

Practice address

11034 N 23Rd Dr # 105B
Phoenix, AZ 85029-4743

Phone

(602) 639-0189

NPI assigned

May 27, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Coronado Surgery Center LLC

  • Ambulatory Surgical Clinic/Center
  • Sierra Vista, AZ
  • NPI 1215489182
  NPD (past)
• Silver Falls Dermatology, LLC

  dba Frontier Dermatology

  • Dermatology Physician
  • Salem, OR
  • NPI 1134375421
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580860800000",
    "number": "1407803588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "165 EL CAMINO REAL",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "856352807",
            "telephone_number": "520-458-5539",
            "fax_number": "520-458-5584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11034 N 23RD DR # 105B",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850294743",
            "telephone_number": "602-639-0189"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "165 El Camino Real",
            "address_purpose": "LOCATION",
            "city": "Sierra Vista",
            "state": "AZ",
            "postal_code": "85635",
            "country_code": "US",
            "telephone_number": "520-458-1787",
            "fax_number": "520-458-1519",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1793 13th St SE",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "OR",
            "postal_code": "973022541",
            "country_code": "US",
            "telephone_number": "503-362-8385",
            "fax_number": "503-362-8435",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOSKI",
        "first_name": "KYLE",
        "middle_name": "L",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-27",
        "last_updated": "2020-02-05",
        "certification_date": "2020-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OR",
            "license": "PA1865293",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AZ",
            "license": "3392",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Courtney C Koshar, MD
• Jacqueline Koshorek, D.O
• Jeannie Kosint
• Zackary Kosisky, OD
• Danielle Koski
• Sandra Koski
• Jennifer Louise Koslo, MS, RD, CSSD
• Madison Adia Kosmatka
• James J Koster, MD
• Kami Koster

• Medical Physician Assistant in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Medical Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.