Basic Information
Provider Information
NPI: 1861633083
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KOVACS
FirstName: DAVID
MiddleName: BRIAN
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 26522 LA ALAMEDA
Address2: SUITE 120
City: MISSION VIEJO
State: CA
PostalCode: 926916330
CountryCode: US
TelephoneNumber: 9492821671
FaxNumber: 9493670518
Practice Location
Address1: 26800 CROWN VALLEY PKWY
Address2: SUITE 330
City: MISSION VIEJO
State: CA
PostalCode: 926916384
CountryCode: US
TelephoneNumber: 9493647246
FaxNumber: 9493641647
Other Information
ProviderEnumerationDate: 03/18/2009
LastUpdateDate: 11/05/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/05/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XA106958CAY Allopathic & Osteopathic PhysiciansInternal Medicine 
208M00000XA106958CAN Allopathic & Osteopathic PhysiciansHospitalist 

No ID Information.


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