Basic Information
| Provider Information | |||||||||
| NPI: | 1144423922 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOKA | ||||||||
| FirstName: | VIJAY | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8876 GULF FREEWAY | ||||||||
| Address2: | SUITE 215 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770176650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7139471001 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3333 BAYSHORE BLVD | ||||||||
| Address2: | SUITE 270 | ||||||||
| City: | PASADENA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775041988 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7139479509 | ||||||||
| FaxNumber: | 7139476286 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2007 | ||||||||
| LastUpdateDate: | 03/23/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | M0132 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 188711901 | 05 | TX | MEDICAID | 188711902 | 05 | TX | MEDICAID |