Provider Demographics
NPI:1952411274
Name:KOKA, KIRAN U (MD)
Entity Type:Individual
Prefix:DR
First Name:KIRAN
Middle Name:U
Last Name:KOKA
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 1:7251 BALMORAL WAY
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-5376
Mailing Address - Country:US
Mailing Address - Phone:925-674-4191
Mailing Address - Fax:925-685-0247
Practice Address - Street 1:2740 GRANT ST
Practice Address - Street 2:SUITE # 255
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2265
Practice Address - Country:US
Practice Address - Phone:925-674-4191
Practice Address - Fax:925-686-0247
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA462182084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA46218OtherPHYSICIAN AND SURGEON
CAA46218OtherPHYSICIAN AND SURGEON
CAA46218OtherPHYSICIAN AND SURGEON