Provider Demographics
NPI:1194906545
Name:KATHY KARAMLOU, M.D., INC., A MEDICAL CORPORATION
Entity type:Organization
Organization Name:KATHY KARAMLOU, M.D., INC., A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:KARAMLOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-631-6500
Mailing Address - Street 1:PO BOX 5688
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92616-5688
Mailing Address - Country:US
Mailing Address - Phone:949-631-6500
Mailing Address - Fax:949-631-9700
Practice Address - Street 1:361 HOSPITAL RD STE 428
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3525
Practice Address - Country:US
Practice Address - Phone:949-631-6500
Practice Address - Fax:949-631-9700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72397207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A723970Medicaid
CA00A723970Medicaid