Provider Demographics
NPI:1063567071
Name:KOUWABUNPAT, DAN (MD)
Entity type:Individual
Prefix:DR
First Name:DAN
Middle Name:
Last Name:KOUWABUNPAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 JOURNEY STE 100
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-3372
Mailing Address - Country:US
Mailing Address - Phone:949-831-4472
Mailing Address - Fax:949-831-6499
Practice Address - Street 1:2 JOURNEY STE 100
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-3372
Practice Address - Country:US
Practice Address - Phone:949-831-4472
Practice Address - Fax:949-831-6499
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67820208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics