PK Cherian MD LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

PK CHERIAN MD LLC

Practice address

758 N Sun Dr Ste 104
Lake Mary, FL 32746-2599

Phone

(407) 333-3303

NPI assigned

Feb 4, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Pothen C Koruth, MD

Title

Physician

Phone

(407) 810-9033

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1612396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612828800000",
    "number": "1841882669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "758 N SUN DR STE 104",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327462599",
            "telephone_number": "407-333-3303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "758 N SUN DR STE 104",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327462599",
            "telephone_number": "407-333-3303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PK CHERIAN MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-04",
        "last_updated": "2021-02-09",
        "certification_date": "2021-02-09",
        "status": "A",
        "authorized_official_last_name": "KORUTH",
        "authorized_official_first_name": "POTHEN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "407-810-9033",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in Lake Mary, FL
• Providers in Lake Mary, FL by specialty
• Primary Care Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.