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COASTAL KIDS A PROFESSIONAL MEDICAL CORPORATION NPI 1740311737


NPI Information

NPI: 1740311737
Provider Name: COASTAL KIDS, A PROFESSIONAL MEDICAL CORPORATION

Doing Business As: COASTAL KIDS

Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 05D0994484

Address:
2071 SAN JOAQUIN HILLS RD
NEWPORT BEACH, CA
ZIP 92660
Phone: (949) 759-1720
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COASTAL KIDS, A PROFESSIONAL MEDICAL CORPORATION is a pediatrics in Newport Beach, CA. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. COASTAL KIDS, A PROFESSIONAL MEDICAL CORPORATION NPI is 1740311737. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Coastal Kids.

The provider's business location address is:

2071 SAN JOAQUIN HILLS RD
NEWPORT BEACH, CA
ZIP 92660-505
Phone: (949) 759-1720
Fax: (949) 759-1442

The provider's authorized official is Kiran Annavarapu .
The authorized official title is Chief Operating Officer and has the following contact phone number (310) 351-8765.

The CLIA number assigned to this NPI record is 05D0994484 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/8/2007 and was last updated on 3/2/2022.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208000000XPediatricsA56395CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
100A563950MEDICAIDCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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