Provider Demographics
NPI:1033159249
Name:MUKAI, JOHN K (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:K
Last Name:MUKAI
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 1:14 RICE RD
Mailing Address - Street 2:
Mailing Address - City:TEMPLETON
Mailing Address - State:MA
Mailing Address - Zip Code:01468-1332
Mailing Address - Country:US
Mailing Address - Phone:978-939-2035
Mailing Address - Fax:978-939-2039
Practice Address - Street 1:14 RICE RD
Practice Address - Street 2:
Practice Address - City:TEMPLETON
Practice Address - State:MA
Practice Address - Zip Code:01468-1332
Practice Address - Country:US
Practice Address - Phone:978-939-2035
Practice Address - Fax:978-939-2039
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2016-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA480832085R0202X, 2085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA754141OtherTUFTS HEALTH PLANS
MA042477296OtherHEALTH CARE VALUE MANAGEM
MA300072285OtherRAILROAD MEDICARE
MA3011097OtherHEALTHY START
MD52277OtherFALLON COMMUNITY HEALTH
MA97653204OtherNETWORK HEALTH
MA0007041OtherNEIGHBORHOOD HEALTH PLAN
MA40007OtherHEALTH NEW ENGLAND
MA042477296OtherPRIVATE HEALTH CARE SYSTE
MA245374OtherHARVARD PILGRIM HEALTH CA
MAJ05768OtherBLUE CROSS BLUE SHIELD
MA3011097Medicaid
MA684010OtherCIGNA
MA754141OtherTUFTS HEALTH PLANS
MAJ05768Medicare ID - Type Unspecified