Provider Demographics
NPI:1093823858
Name:UMEKUBO, JOHN I (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:I
Last Name:UMEKUBO
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 1:1674 POST ST
Mailing Address - Street 2:STE 3
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115
Mailing Address - Country:US
Mailing Address - Phone:415-931-5182
Mailing Address - Fax:415-931-1563
Practice Address - Street 1:1674 POST ST
Practice Address - Street 2:STE 3
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115
Practice Address - Country:US
Practice Address - Phone:415-931-5182
Practice Address - Fax:415-931-1563
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37604207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G376040Medicaid
CA8039318OtherPIN (MEDI-CAL)
A47155Medicare UPIN
CA00G376040Medicaid