MEDICARE: KIRAN U. KOKA, M.D. - A PROFESSIONAL CORP

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	2084P0800X	Psychiatry Physician	A46218	CA
2	2084P0804X	Child & Adolescent Psychiatry Physician	A46218	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A46218	OTHER	CA	PHYSICIAN AND SURGEON
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679598338
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIRAN U. KOKA, M.D. - A PROFESSIONAL CORP

Provider Business Mailing Address
First Line	:	604 TIMBERLEAF CT
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94598-5406
Country	:	US
Telephone Number	:	925-256-1486
Fax Number	:	925-256-1486

Provider Business Practice Location Address
First Line	:	49 QUAIL CT
Second Line	:	SUITE # 209
City	:	WALNUT CREEK
State	:	CA
Zip	:	94596-5550
Country	:	US
Telephone Number	:	925-674-4191
Fax Number	:	925-686-0247

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KIRAN U. KOKA
Credential	:	M.D.
Telephone Number	:	925-934-8153

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	03/07/2023

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