Provider Demographics
NPI:1306063276
Name:KOVASH, NANETTE LE (DO)
Entity type:Individual
Prefix:DR
First Name:NANETTE
Middle Name:LE
Last Name:KOVASH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:NANETTE
Other - Middle Name:HONG
Other - Last Name:LE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 255228
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95865-5228
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:916-854-6769
Practice Address - Street 1:3161 L ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5234
Practice Address - Country:US
Practice Address - Phone:916-878-3495
Practice Address - Fax:916-736-5533
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2025-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A102712085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0020A1027100OtherBC/BS OF CA
CA20A102710Medicaid
CA1306063276Medicaid
CA20A102710Medicaid
CACB229286Medicare PIN
CAW20A10271BMedicare PIN