Provider Demographics
NPI:1336104272
Name:OCHIKUBO, CLARK (MD)
Entity Type:Individual
Prefix:DR
First Name:CLARK
Middle Name:
Last Name:OCHIKUBO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1135 S SUNSET AVE
Mailing Address - Street 2:SUITE 406
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3937
Mailing Address - Country:US
Mailing Address - Phone:626-813-3716
Mailing Address - Fax:626-813-3720
Practice Address - Street 1:1135 S SUNSET AVE
Practice Address - Street 2:SUITE 406
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3937
Practice Address - Country:US
Practice Address - Phone:626-813-3716
Practice Address - Fax:626-813-3720
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG0722522080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine