Provider Demographics
NPI:1851537708
Name:P K A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:P K A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:KOUWABUNPAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-497-9609
Mailing Address - Street 1:1610 W EDINGER AVE
Mailing Address - Street 2:STE B
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-4339
Mailing Address - Country:US
Mailing Address - Phone:714-641-1610
Mailing Address - Fax:714-641-1146
Practice Address - Street 1:1610 W EDINGER AVE STE B
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-4339
Practice Address - Country:US
Practice Address - Phone:714-641-1610
Practice Address - Fax:714-641-1146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-24
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care