Provider Demographics
NPI:1891787776
Name:PAUL S AIJIAN MD WILLIAM C KOONCE MD
Entity Type:Organization
Organization Name:PAUL S AIJIAN MD WILLIAM C KOONCE MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:S
Authorized Official - Last Name:AIJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-682-7200
Mailing Address - Street 1:219 NOGALES AVE
Mailing Address - Street 2:STE B
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-3848
Mailing Address - Country:US
Mailing Address - Phone:805-682-7200
Mailing Address - Fax:
Practice Address - Street 1:219 NOGALES AVE
Practice Address - Street 2:STE B
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-3848
Practice Address - Country:US
Practice Address - Phone:805-682-7200
Practice Address - Fax:805-682-3278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-17
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAPAWK0802PRFOtherBLUE CROSS SUBMITTER ID #
CAYYY50118YOtherBLUE SHIELD PROVIDER ID #
CAGR0048120Medicaid
CAYYY50118YOtherBLUE SHIELD PROVIDER ID #