Organization
AUDREY KONOW M.D. A PROFESSIONAL CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AUDREY KONOW M.D. (PRESIDENT)
(714) 961-8500
Entity
Organization
Contact information
Practice address
5150 E LA PALMA AVE STE 106, ANAHEIM, CA 92807-2085
(714) 975-1507
(714) 340-0606
Mailing address
5150 E LA PALMA AVE STE 106, ANAHEIM, CA 92807-2085
(714) 975-1507
(714) 340-0606
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
G32179
CA
207R00000X
Internal Medicine Physician
Primary
G32179
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004110236
AETNA
CA
01
—
00G321790
BLUE SHIELD CA
CA
01
—
1659481125
INDIVIDUAL NPI
CA
Enumeration date
08/20/2007
Last updated
05/31/2024
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