Provider Demographics
NPI:1053677914
Name:KOFI KESSEY MD/PHD INC. A CALIFORNIA PROFESSIONAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:KOFI KESSEY MD/PHD INC. A CALIFORNIA PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KOFI
Authorized Official - Middle Name:
Authorized Official - Last Name:KESSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-850-5999
Mailing Address - Street 1:351 ROLLING OAKS DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-1275
Mailing Address - Country:US
Mailing Address - Phone:805-379-3368
Mailing Address - Fax:805-379-3360
Practice Address - Street 1:351 ROLLING OAKS DR
Practice Address - Street 2:SUITE 204
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-1275
Practice Address - Country:US
Practice Address - Phone:805-379-3368
Practice Address - Fax:805-379-3360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-04
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94613207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty