Provider Demographics
NPI:1851429260
Name:KONSTANTINOS VLACHONASSIOS MD INC
Entity Type:Organization
Organization Name:KONSTANTINOS VLACHONASSIOS MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KONSTANTINOS
Authorized Official - Middle Name:
Authorized Official - Last Name:VLACHONASSIOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-622-9500
Mailing Address - Street 1:19051 GOLDENWEST ST
Mailing Address - Street 2:SUITE 106321
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-2155
Mailing Address - Country:US
Mailing Address - Phone:562-622-9500
Mailing Address - Fax:562-622-9513
Practice Address - Street 1:11101 LA REINA AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-4237
Practice Address - Country:US
Practice Address - Phone:562-622-9500
Practice Address - Fax:562-622-9513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19102Medicare ID - Type Unspecified