1851429260 NPI number — KONSTANTINOS VLACHONASSIOS MD INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851429260 NPI number — KONSTANTINOS VLACHONASSIOS MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KONSTANTINOS VLACHONASSIOS MD INC
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:
1851429260
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19051 GOLDENWEST ST
Provider Second Line Business Mailing Address:
SUITE 106321
Provider Business Mailing Address City Name:
HUNTINGTON BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92648-2155
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-622-9500
Provider Business Mailing Address Fax Number:
562-622-9513

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3300 E SOUTH STREET
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-622-9500
Provider Business Practice Location Address Fax Number:
562-622-9513
Provider Enumeration Date:
02/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VLACHONASSIOS
Authorized Official First Name:
KONSTANTINOS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
562-622-9500

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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