Provider Demographics
NPI:1083400220
Name:MARY J. KOTOB, MD, INC
Entity type:Organization
Organization Name:MARY J. KOTOB, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOTOB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-357-3202
Mailing Address - Street 1:400 NEWPORT CENTER DR STE 202
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7639
Mailing Address - Country:US
Mailing Address - Phone:949-520-7774
Mailing Address - Fax:949-520-7731
Practice Address - Street 1:400 NEWPORT CENTER DR STE 202
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7639
Practice Address - Country:US
Practice Address - Phone:949-520-7774
Practice Address - Fax:949-520-7731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty