Provider Demographics
NPI:1134111958
Name:KOUMAS, JOHN C (DO)
Entity Type:Individual
Prefix:MRS
First Name:JOHN
Middle Name:C
Last Name:KOUMAS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:767 S SUNSET AVE
Mailing Address - Street 2:STE. #4
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3546
Mailing Address - Country:US
Mailing Address - Phone:626-337-7204
Mailing Address - Fax:626-851-1855
Practice Address - Street 1:1135 S SUNSET AVE STE 200
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3964
Practice Address - Country:US
Practice Address - Phone:626-732-8390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A5515207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE97960Medicare UPIN