Provider Demographics
NPI:1629299060
Name:CALIFORNIA COAST MEDICAL CENTER
Entity Type:Organization
Organization Name:CALIFORNIA COAST MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:KOCKINIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-596-1105
Mailing Address - Street 1:18811 HUNTINGTON ST
Mailing Address - Street 2:SUITE #130
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-6002
Mailing Address - Country:US
Mailing Address - Phone:714-596-1105
Mailing Address - Fax:714-596-1155
Practice Address - Street 1:18811 HUNTINGTON ST
Practice Address - Street 2:SUITE #130
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-6002
Practice Address - Country:US
Practice Address - Phone:714-596-1105
Practice Address - Fax:714-596-1155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40769207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty