Provider Demographics
NPI:1679598338
Name:KIRAN U. KOKA, M.D. - A PROFESSIONAL CORP
Entity Type:Organization
Organization Name:KIRAN U. KOKA, M.D. - A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIRAN
Authorized Official - Middle Name:U
Authorized Official - Last Name:KOKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-934-8153
Mailing Address - Street 1:604 TIMBERLEAF CT
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-5406
Mailing Address - Country:US
Mailing Address - Phone:925-256-1486
Mailing Address - Fax:925-256-1486
Practice Address - Street 1:49 QUAIL CT
Practice Address - Street 2:SUITE # 209
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5550
Practice Address - Country:US
Practice Address - Phone:925-674-4191
Practice Address - Fax:925-686-0247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA462182084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA46218OtherPHYSICIAN AND SURGEON
CA00A46218Medicaid
CA00A46218Medicaid
BK1696876OtherDEA #