MEDICARE: EWA HANNA KONCA 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	207R00000X	Internal Medicine Physician	A66917	CA
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	A66917	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134197528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EWA HANNA KONCA MD

Provider Business Mailing Address
First Line	:	840 TOWNE CENTER DR
Second Line	:
City	:	POMONA
State	:	CA
Zip	:	91767-5900
Country	:	US
Telephone Number	:	909-398-1550
Fax Number	:	909-398-1488

Provider Business Practice Location Address
First Line	:	520 W. FOOTHILL BLVD
Second Line	:	SUITE A
City	:	POMONA
State	:	CA
Zip	:	91767-3031
Country	:	US
Telephone Number	:	909-622-3065
Fax Number	:	909-784-3399

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

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	09/25/2023

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Directions to “ EWA HANNA KONCA MD” Practice Location

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