Provider Demographics
NPI:1588655658
Name:KARIYA, ENA M (MD)
Entity Type:Individual
Prefix:DR
First Name:ENA
Middle Name:M
Last Name:KARIYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2742 DOW AVE
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-7242
Mailing Address - Country:US
Mailing Address - Phone:714-665-1600
Mailing Address - Fax:
Practice Address - Street 1:722 BAKER ST
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4320
Practice Address - Country:US
Practice Address - Phone:714-557-6300
Practice Address - Fax:714-966-9567
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87623207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A876230Medicaid
CAI29676Medicare UPIN
CAEO345ZMedicare PIN
CAWA87623AMedicare PIN