Healthcare Provider Details

I. General information

NPI: 1437179736
Provider Name (Legal Business Name): CHRISTIAN ADAM KOCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W CALIFORNIA BLVD
PASADENA CA
91105-3010
US

IV. Provider business mailing address

225 S LAKE AVE 535
PASADENA CA
91101-3005
US

V. Phone/Fax

Practice location:
  • Phone: 626-397-5000
  • Fax: 626-397-2912
Mailing address:
  • Phone: 626-795-6596
  • Fax: 626-795-8247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA83415
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: