Healthcare Provider Details

I. General information

NPI: 1952312712
Provider Name (Legal Business Name): THOMAS CHRISTOPHER KOCKINIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 08/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18811 HUNTINGTON STREET SUITE 130
HUNTINGTON BEACH CA
92648-6003
US

IV. Provider business mailing address

18811 HUNTINGTON STREET SUITE 130
HUNTINGTON BEACH CA
92648-6003
US

V. Phone/Fax

Practice location:
  • Phone: 714-596-1105
  • Fax: 714-596-1155
Mailing address:
  • Phone: 714-596-1105
  • Fax: 714-596-1155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA40769
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number5084
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: