MEDICARE: KATHLEEN MARIE LAUGHLIN M.D

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	207Q00000X	Family Medicine Physician	G081959	CA

General Provider Information

NPI Number	:	1346282720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN MARIE LAUGHLIN M.D

Provider Business Mailing Address
First Line	:	PO BOX 16027
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92659-6027
Country	:	US
Telephone Number	:	949-644-1025
Fax Number	:	949-644-7072

Provider Business Practice Location Address
First Line	:	360 SAN MIGUEL DR STE 501
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-7831
Country	:	US
Telephone Number	:	949-644-1025
Fax Number	:	949-644-7072

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

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	02/11/2022

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