Provider Demographics
NPI:1235592718
Name:KOVZUN, KUZMA
Entity type:Individual
Prefix:
First Name:KUZMA
Middle Name:
Last Name:KOVZUN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8775 SIERRA COLLEGE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-5985
Mailing Address - Country:US
Mailing Address - Phone:844-867-8444
Mailing Address - Fax:
Practice Address - Street 1:8775 SIERRA COLLEGE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-5985
Practice Address - Country:US
Practice Address - Phone:448-678-4448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-01
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDOS18462084P0800X
CA20A218892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry