Provider Demographics
NPI:1235728494
Name:GOZUN, MAAN KATHRYN LAQUINDANUM (MD)
Entity type:Individual
Prefix:
First Name:MAAN KATHRYN
Middle Name:LAQUINDANUM
Last Name:GOZUN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MAAN KATHRYN
Other - Middle Name:SANTOS
Other - Last Name:LAQUINDANUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7551 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-7449
Mailing Address - Country:US
Mailing Address - Phone:916-904-3000
Mailing Address - Fax:916-946-9733
Practice Address - Street 1:7551 MADISON AVE
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-7449
Practice Address - Country:US
Practice Address - Phone:916-904-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI8032207R00000X
CAA194161207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine