Provider Demographics
NPI:1497748958
Name:MIKUNI, KAREN S (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:S
Last Name:MIKUNI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2050 S BLOSSER RD
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-7310
Mailing Address - Country:US
Mailing Address - Phone:805-361-8028
Mailing Address - Fax:805-361-8097
Practice Address - Street 1:2120 CIENAGA ST
Practice Address - Street 2:
Practice Address - City:OCEANO
Practice Address - State:CA
Practice Address - Zip Code:93445-9016
Practice Address - Country:US
Practice Address - Phone:805-994-2100
Practice Address - Fax:805-994-2197
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG74101207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080142127OtherRAILROAD MEDICARE
CA00G741010Medicaid
CACB207799OtherMEDICARE ID
CA00G741010OtherBLUE SHIELD OF CALIFORNIA