P K a Medical Corporation

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

P K A MEDICAL CORPORATION

Practice address

1610 W Edinger Ave Ste B
Santa Ana, CA 92704-4339

Phone

(714) 641-1610

Fax

(714) 641-1146

NPI assigned

Dec 24, 2008

Last updated

Feb 23, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Pat Kouwabunpat, MDNPI 1063625069

Title

President / Physician

Phone

(626) 497-9609

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Interoperability endpoints

• Direct secure messaging: arpawong@direct.practicefusion.com

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Pat T Kouwabunpat, MD

  • Family Medicine Physician
  • Santa Ana, CA
  • NPI 1063625069
  Medicare reassignment NPD Authorized official
• Pumipak Tantamjarik, MD, FAAFP

  • Family Medicine Physician
  • Santa Ana, CA
  • NPI 1891789566
  NPD
• Maidiana Anh English, PA-C

  • Physician Assistant
  • Santa Ana, CA
  • NPI 1487906715
  NPD (past)
• Sasithorn Ratanaprakarn Jitpakdee, M.D.

  • Family Medicine Physician
  • Santa Ana, CA
  • NPI 1699871467
  NPD (past)
• Triet Sy Nguyen, PA-C

  • Medical Physician Assistant
  • Santa Ana, CA
  • NPI 1619167558
  NPD (past)
• Srivimol Tantamjarik, M.D., F.A.A.P.

  • Pediatrics Physician
  • Santa Ana, CA
  • NPI 1508828856
  NPD (past)

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

{
    "created_epoch": "1230076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677110400000",
    "number": "1851537708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1610 W EDINGER AVE",
            "address_2": "STE B",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927044339",
            "telephone_number": "714-641-1610",
            "fax_number": "714-641-1146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1610 W EDINGER AVE STE B",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927044339",
            "telephone_number": "714-641-1610",
            "fax_number": "714-641-1146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "P K A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-24",
        "last_updated": "2023-02-23",
        "certification_date": "2023-02-23",
        "status": "A",
        "authorized_official_last_name": "KOUWABUNPAT",
        "authorized_official_first_name": "PAT",
        "authorized_official_title_or_position": "PRESIDENT / PHYSICIAN",
        "authorized_official_telephone_number": "626-497-9609",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "arpawong@direct.practicefusion.com",
            "affiliation": "N",
            "endpointDescription": "Practice Fusion EHR",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "xml",
            "address_1": "1610 W Edinger Ave",
            "address_2": "Ste B",
            "city": "Santa Ana",
            "state": "CA",
            "country_code": "US",
            "postal_code": "927044339",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• William John Owens
• Diana Owrey, MPT
• Chika Owuama
• Noelle Owusu
• Melanie Mai-Lien Ozgur, OD
• Paalani Chiropratic Inc. (Agape Wellness Center)
• Jennifer K. Paalani, D.C.
• Justin Pabalate
• Warren Pabale
• Paige Pabico

• Primary Care Clinic/Center in Santa Ana, CA
• Providers in Santa Ana, CA by specialty
• Primary Care Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.