Provider Demographics
NPI:1679671259
Name:KOKINOS, POLYXENE G (MD)
Entity Type:Individual
Prefix:DR
First Name:POLYXENE
Middle Name:G
Last Name:KOKINOS
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 1:2255 SOUTH BASCOM AVENUE
Mailing Address - Street 2:STE 200
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008
Mailing Address - Country:US
Mailing Address - Phone:408-376-3626
Mailing Address - Fax:408-871-2377
Practice Address - Street 1:2255 S BASCOM AVE
Practice Address - Street 2:STE 200
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-7800
Practice Address - Country:US
Practice Address - Phone:408-376-3626
Practice Address - Fax:408-871-2377
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG669460174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF95840Medicare UPIN
CAF958409Medicare UPIN
CA1679671259Medicare PIN
CA00G669460Medicare ID - Type Unspecified