MEDICARE: DR. THOMAS CHRISTOPHER KOCKINIS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	A40769	CA
2	208VP0014X	Interventional Pain Medicine Physician	5084	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00A407691	OTHER		MEDICAL

General Provider Information

NPI Number	:	1952312712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS CHRISTOPHER KOCKINIS MD

Provider Business Mailing Address
First Line	:	18811 HUNTINGTON STREET
Second Line	:	SUITE 130
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-6003
Country	:	US
Telephone Number	:	714-596-1105
Fax Number	:	714-596-1155

Provider Business Practice Location Address
First Line	:	18811 HUNTINGTON STREET
Second Line	:	SUITE 130
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-6003
Country	:	US
Telephone Number	:	714-596-1105
Fax Number	:	714-596-1155

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	08/09/2011

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