Provider Demographics
NPI:1205926177
Name:ANDO, LINDA KOUCHI (MD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:KOUCHI
Last Name:ANDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LINDA
Other - Middle Name:CHIYE
Other - Last Name:KOUCHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1050 LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-3321
Mailing Address - Country:US
Mailing Address - Phone:562-491-9755
Mailing Address - Fax:562-491-7975
Practice Address - Street 1:1050 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3321
Practice Address - Country:US
Practice Address - Phone:562-491-9755
Practice Address - Fax:562-491-7975
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG70763207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G707630Medicaid
CAF50643Medicare UPIN
CAWG70763PMedicare ID - Type Unspecified