=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821004623
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRUCE W. KOVACS, MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2006
-----------------------------------------------------
Last Update Date | 11/06/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12555 GARDEN GROVE BLVD SUITE 203
-----------------------------------------------------
City | GARDEN GROVE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92843-1902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-491-9809
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3389
-----------------------------------------------------
City | SEAL BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90740-2389
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-773-3155
-----------------------------------------------------
Fax | 562-498-0205
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | BRUCE KOVACS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 562-773-3155
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VM0101X
-----------------------------------------------------
Taxonomy Name | Maternal & Fetal Medicine Physician
-----------------------------------------------------
License Number | G42117
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------