1043670490 NPI number — THOTA & KOKA, AMC

Table of content: (NPI 1043670490)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043670490 NPI number — THOTA & KOKA, AMC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOTA & KOKA, AMC
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:
1043670490
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2732 NAVAJO RD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
EL CAJON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92020-2149
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-287-7246
Provider Business Mailing Address Fax Number:
619-825-8250

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2732 NAVAJO RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
EL CAJON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92020-2149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-287-7246
Provider Business Practice Location Address Fax Number:
619-825-8250
Provider Enumeration Date:
02/27/2016

Additional Information

Authorized Official

Authorized Official Last Name:
THOTA
Authorized Official First Name:
KRISH
Authorized Official Middle Name:
R
Authorized Official Title or Position:
MANAGING DIRECTOR
Authorized Official Telephone Number:
619-287-7246

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , with the licence number:  G84603 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0000X , with the licence number: A53526 , 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: A53526 . This is a "STATE LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com