Provider Demographics
NPI:1851380729
Name:MCGOWAN, KAREN A (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:A
Last Name:MCGOWAN
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 1:8908 ALLENBROOK WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-2162
Mailing Address - Country:US
Mailing Address - Phone:858-459-5437
Mailing Address - Fax:
Practice Address - Street 1:5726 LA JOLLA BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-7344
Practice Address - Country:US
Practice Address - Phone:858-459-5437
Practice Address - Fax:858-459-5459
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60624208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A606240Medicare ID - Type Unspecified
CAW7168Medicare UPIN