Provider Demographics
NPI:1871537035
Name:ROSS, KATHRYN A (MD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:A
Last Name:ROSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 DOVER DR
Mailing Address - Street 2:SUITE 122
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-5538
Mailing Address - Country:US
Mailing Address - Phone:949-650-8700
Mailing Address - Fax:949-650-0877
Practice Address - Street 1:901 DOVER DR
Practice Address - Street 2:SUITE 122
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-5538
Practice Address - Country:US
Practice Address - Phone:949-650-8700
Practice Address - Fax:949-650-0877
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42979207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G429790Medicaid
WG42979BOtherMEDICARE PTAN
CAG57562Medicare UPIN