MEDICARE: KATHY KARAMLOU 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	207RR0500X	Rheumatology Physician	A72397	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	WA72397C	OTHER	CA	MEDICARE INDIVIDUAL PTAN
3	W21789	OTHER	CA	MEDICARE GROUP PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00A723970	OTHER	CA	MEDI-CAL

General Provider Information

NPI Number	:	1740209303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY KARAMLOU MD

Provider Business Mailing Address
First Line	:	PO BOX 5688
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92616-5688
Country	:	US
Telephone Number	:	949-631-6500
Fax Number	:	949-631-9700

Provider Business Practice Location Address
First Line	:	361 HOSPITAL RD STE 428
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-3525
Country	:	US
Telephone Number	:	949-631-6500
Fax Number	:	949-631-9700

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	03/23/2021

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