Provider Demographics
NPI:1003927567
Name:KANO, CHARLIE LOC (MD)
Entity Type:Individual
Prefix:
First Name:CHARLIE
Middle Name:LOC
Last Name:KANO
Suffix:
Gender:M
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:PO BOX 3768
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95344-3768
Mailing Address - Country:US
Mailing Address - Phone:209-723-3704
Mailing Address - Fax:209-726-0272
Practice Address - Street 1:127 W EL PORTAL DR
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-2853
Practice Address - Country:US
Practice Address - Phone:209-723-3704
Practice Address - Fax:209-723-0272
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG74907207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G749070Medicaid
GA080057147Medicare PIN
CAF91602Medicare UPIN
00G749070Medicare PIN