Active NPI
Valeria I Kozak, MD
- Pediatrics Physician
- Tustin, CA
National Provider Identifier
1720057516
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- A89502
- Practice address
- 14642 Newport Ave
Suite 410
Tustin, CA 92780-6057 - Phone
- (714) 838-0022
- Fax
- (714) 838-0060
- NPI assigned
- Mar 15, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | A89502 | CA | Primary |
| Pediatric Adolescent Medicine Physician | 2080A0000X | A89502 | CA |
Addresses
Primary practice location
14642 Newport Ave
Suite 410
Tustin, CA 92780-6057
Mailing address
14642 Newport Ave
Suite 410
Tustin, CA 92780-6057
Phone (714) 838-0022
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A89502 | CA | MD | Pediatric Adolescent Medicine Physician |
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142380800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1235692800000",
"number": "1720057516",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14642 NEWPORT AVE",
"address_2": "SUITE 410",
"city": "TUSTIN",
"state": "CA",
"postal_code": "927806057",
"telephone_number": "714-838-0022",
"fax_number": "714-838-0060"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14642 NEWPORT AVE",
"address_2": "SUITE 410",
"city": "TUSTIN",
"state": "CA",
"postal_code": "927806057",
"telephone_number": "714-838-0022",
"fax_number": "714-838-0060"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOZAK",
"first_name": "VALERIA",
"middle_name": "I",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-03-15",
"last_updated": "2009-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "A89502",
"primary": true
},
{
"code": "2080A0000X",
"taxonomy_group": "",
"desc": "Pediatrics, Adolescent Medicine",
"state": "CA",
"license": "A89502",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tustin, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.