Provider Demographics
NPI:1336192327
Name:MALKASIAN, KATHERINE L (MD)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:L
Last Name:MALKASIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:400 NEWPORT CENTER DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7601
Mailing Address - Country:US
Mailing Address - Phone:949-644-1943
Mailing Address - Fax:949-644-1911
Practice Address - Street 1:400 NEWPORT CENTER DR
Practice Address - Street 2:SUITE 310
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7601
Practice Address - Country:US
Practice Address - Phone:949-644-1943
Practice Address - Fax:949-644-1911
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA26287207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A262870Medicaid
CA00A262870Medicaid
CAH42800Medicare UPIN