Provider Demographics
NPI:1952312712
Name:KOCKINIS, THOMAS CHRISTOPHER (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:CHRISTOPHER
Last Name:KOCKINIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18811 HUNTINGTON STREET
Mailing Address - Street 2:SUITE 130
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-6003
Mailing Address - Country:US
Mailing Address - Phone:714-596-1105
Mailing Address - Fax:714-596-1155
Practice Address - Street 1:18811 HUNTINGTON STREET
Practice Address - Street 2:SUITE 130
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-6003
Practice Address - Country:US
Practice Address - Phone:714-596-1105
Practice Address - Fax:714-596-1155
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40769207Q00000X
CA5084208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A407691OtherMEDICAL
00A407691OtherMEDICAL
W11807Medicare ID - Type Unspecified