Provider Demographics
NPI:1306063276
Name:KOVASH, NANETTE LE (DO)
Entity type:Individual
Prefix:DR
First Name:NANETTE
Middle Name:LE
Last Name:KOVASH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:NANETTE
Other - Middle Name:HONG
Other - Last Name:LE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:12401 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-1006
Mailing Address - Country:US
Mailing Address - Phone:562-698-0811
Mailing Address - Fax:562-309-8200
Practice Address - Street 1:12401 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-1006
Practice Address - Country:US
Practice Address - Phone:562-698-0811
Practice Address - Fax:562-309-8200
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A102712085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0020A1027100OtherBC/BS OF CA
CA20A102710Medicaid
CA1306063276Medicaid
CA20A102710Medicaid
CACB229286Medicare PIN
CAW20A10271BMedicare PIN