Provider Demographics
NPI:1629074976
Name:KOVACS, BRUCE W (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:W
Last Name:KOVACS
Suffix:
Gender:M
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:PO BOX 3389
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-2389
Mailing Address - Country:US
Mailing Address - Phone:562-773-3155
Mailing Address - Fax:562-498-0205
Practice Address - Street 1:12401 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-1018
Practice Address - Country:US
Practice Address - Phone:562-693-7778
Practice Address - Fax:562-693-3681
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42117207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G421170Medicaid
CAF13124Medicare UPIN
CA00G421170Medicaid