Provider Demographics
NPI:1356361166
Name:PACIFIC COAST GASTROENTEROLOGY, INC
Entity type:Organization
Organization Name:PACIFIC COAST GASTROENTEROLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JACOB
Authorized Official - Last Name:KAUFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:949-727-2035
Mailing Address - Street 1:18 ENDEAVOR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3164
Mailing Address - Country:US
Mailing Address - Phone:949-727-2035
Mailing Address - Fax:949-727-2141
Practice Address - Street 1:18 ENDEAVOR
Practice Address - Street 2:SUITE 204
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3164
Practice Address - Country:US
Practice Address - Phone:949-727-2035
Practice Address - Fax:949-727-2141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8799207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty