Provider Demographics
NPI:1063625069
Name:KOUWABUNPAT, PAT T (MD)
Entity type:Individual
Prefix:DR
First Name:PAT
Middle Name:T
Last Name:KOUWABUNPAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1610 W EDINGER AVE
Mailing Address - Street 2:STE B
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-4339
Mailing Address - Country:US
Mailing Address - Phone:714-641-1610
Mailing Address - Fax:714-641-1146
Practice Address - Street 1:1610 W EDINGER AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-4339
Practice Address - Country:US
Practice Address - Phone:714-641-1610
Practice Address - Fax:714-641-1146
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA97918207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A979180Medicaid