1679598338 NPI number — KIRAN U. KOKA, M.D. - A PROFESSIONAL CORP

Table of content: (NPI 1679598338)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679598338 NPI number — KIRAN U. KOKA, M.D. - A PROFESSIONAL CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIRAN U. KOKA, M.D. - A PROFESSIONAL CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679598338
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
604 TIMBERLEAF CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALNUT CREEK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94598-5406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-256-1486
Provider Business Mailing Address Fax Number:
925-256-1486

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
49 QUAIL CT
Provider Second Line Business Practice Location Address:
SUITE # 209
Provider Business Practice Location Address City Name:
WALNUT CREEK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94596-5550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-674-4191
Provider Business Practice Location Address Fax Number:
925-686-0247
Provider Enumeration Date:
07/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KOKA
Authorized Official First Name:
KIRAN
Authorized Official Middle Name:
U.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
925-934-8153

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  A46218 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0804X , with the licence number: A46218 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: A46218 . This is a "PHYSICIAN AND SURGEON" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A46218 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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