Golzar Kouklan, BS

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

30945 Issued in CA

Practice address

434 E 4TH St
Long Beach, CA 90802-2405

Phone

(630) 715-2520

NPI assigned

Feb 29, 2012

Sex

Female

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

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

San Diego Brainworks Psychology and Neuropsychology ServicesGroup PAC ID 0244451052, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Bachelor of Science

State licenses

Practice roles

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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

• San Diego Brainworks Psychology & Neuropsychology Services

  • Psychologist
  • San Diego, CA
  • NPI 1427458710
  Medicare reassignment Care Compare group
• Center for Family Health and Education Inc

  • Federally Qualified Health Center (FQHC)
  • Mission Hills, CA
  • NPI 1689199648
  NPD (past)

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

{
    "created_epoch": "1330473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567036800000",
    "number": "1649544289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1020 N 12TH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532331308",
            "telephone_number": "414-219-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "434 E 4TH ST",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908022405",
            "telephone_number": "630-715-2520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOUKLAN",
        "first_name": "GOLZAR",
        "credential": "BS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-02-29",
        "last_updated": "2019-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "WI",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "30945",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathleen Ann Kosche, LCSW
• Perry R Koseff, DO
• Jennifer Kosel, RKT
• Nicholas Elijah Kosht
• Madeleine Hope Koster
• Manuelda Koumba Dike
• Stephen T. Kouri, M.D.
• Julie Elizabeth Kovac, LCSW
• Margaret A Kovacs, MFTI
• James Edward Koval, PH.D.

• Clinical Psychologist in Long Beach, CA
• Providers in Long Beach, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.