Christine Suzanne Koselak

Primary specialty

SpecialistTaxonomy code 174400000X

License

30000094L Issued in CA

Practice address

1936 Camden Ave Ste 9
San Jose, CA 95124-2845

Phone

(650) 346-4111

NPI assigned

Aug 15, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1502755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623628800000",
    "number": "1669998324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14567 BIG BASIN WAY STE D2",
            "city": "SARATOGA",
            "state": "CA",
            "postal_code": "950706039",
            "telephone_number": "650-346-4111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1936 CAMDEN AVE STE 9",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951242845",
            "telephone_number": "650-346-4111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOSELAK",
        "first_name": "CHRISTINE",
        "middle_name": "SUZANNE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-08-15",
        "last_updated": "2021-06-14",
        "certification_date": "2021-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "30000094L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diana Vallarta Koroi, LM, CPM
• Moses Koroma
• Alexander Korsunsky, M.D.
• Jesse Korth, NP-C
• Gail Ann Korza, MHRS
• Diane Miye Koshimune, DPM
• Shane Michael Koss
• Amy L Kostishack, MD
• Maria Kaite Kostouros
• Andrew Kotch

• Specialist in San Jose, CA
• Providers in San Jose, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2021; 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.