Provider Demographics
NPI:1831382662
Name:PERKINS TIFT, KATHRYN CALDWELL (MD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:CALDWELL
Last Name:PERKINS TIFT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATHRYN
Other - Middle Name:CALDWELL
Other - Last Name:PERKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11160 WARNER AVE STE 311
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4055
Mailing Address - Country:US
Mailing Address - Phone:714-850-7300
Mailing Address - Fax:714-957-7348
Practice Address - Street 1:11160 WARNER AVE
Practice Address - Street 2:SUITE 311
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4055
Practice Address - Country:US
Practice Address - Phone:714-850-7300
Practice Address - Fax:714-850-7310
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA104909207XP3100X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA104909OtherMEDICAL LICENSE