Provider Demographics
NPI:1811920424
Name:DIX, KAREN T (MD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:T
Last Name:DIX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 E SAN ANTONIO DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2204
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:911 E SAN ANTONIO DR
Practice Address - Street 2:SUITE 4
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2204
Practice Address - Country:US
Practice Address - Phone:562-728-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG40807207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F52361Medicare UPIN
WG40807DMedicare PIN