Provider Demographics
NPI:1083770440
Name:NAKAMOTO, JON MASAO (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:MASAO
Last Name:NAKAMOTO
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28562 OSO PKWY # 137
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-5595
Mailing Address - Country:US
Mailing Address - Phone:949-709-8299
Mailing Address - Fax:949-728-4960
Practice Address - Street 1:33608 ORTEGA HWY
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-2042
Practice Address - Country:US
Practice Address - Phone:949-728-4323
Practice Address - Fax:949-728-4960
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG605792080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF49083Medicare UPIN