| Kaizen Brain Center | |
|
4180 La Jolla Village Dr Ste 240 La Jolla CA 92037 | |
| (866) 277-2659 | |
| (858) 779-2511 |
| Full Name | Kaizen Brain Center |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 4180 La Jolla Village Dr Ste 240, La Jolla, California |
| Authorized Official Name and Position | Mohammed Muzammil Ahmed (OWNER) |
| Authorized Official Contact | 2148930542 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kaizen Brain Center 4180 La Jolla Village Dr Ste 240 La Jolla CA 92037-1471 Ph: (866) 277-2659 | Kaizen Brain Center 4180 La Jolla Village Dr Ste 240 La Jolla CA 92037 Ph: (866) 277-2659 |
| NPI Number | 1154864874 |
|---|---|
| Provider Enumeration Date | 11/29/2016 |
| Last Update Date | 07/11/2023 |
| Certification Date | 07/11/2023 |
| Medicare PECOS PAC ID | 6103109327 |
|---|---|
| Medicare Enrollment ID | O20170214002554 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154864874 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084B0040X | Psychiatry & Neurology - Behavioral Neurology & Neuropsychiatry | A124696 (California) | Primary |
| Provider Name | Mohammed M Ahmed |
|---|---|
| Provider Type | Practitioner - Neuropsychiatry |
| Provider Identifiers | NPI Number: 1184856916 PECOS PAC ID: 0446488217 Enrollment ID: I20140124001688 |
| Provider Name | Hossein Ansari |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1578774949 PECOS PAC ID: 6901076108 Enrollment ID: I20150529002442 |
| Provider Name | Janne Kristoffer Nissinen |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1710278569 PECOS PAC ID: 6800192394 Enrollment ID: I20170724003070 |
| Provider Name | Kristoffer Allan Ancho |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700199205 PECOS PAC ID: 7416337159 Enrollment ID: I20220712001095 |
| Provider Name | Marisa Pappas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639792187 PECOS PAC ID: 1951743863 Enrollment ID: I20240523002162 |
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