Healthcare Provider Details

I. General information

NPI: 1669417598
Provider Name (Legal Business Name): EDWARD J PLECHA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4647 ZION AVE KAISER PERMANENTE
SAN DIEGO CA
92120-2507
US

IV. Provider business mailing address

4647 ZION AVE KAISER PERMANENTE
SAN DIEGO CA
92120-2507
US

V. Phone/Fax

Practice location:
  • Phone: 619-528-7524
  • Fax: 619-528-7541
Mailing address:
  • Phone: 619-528-7524
  • Fax: 619-528-7541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberA52040
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number2025-00589
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: