Provider Demographics
NPI:1528027497
Name:JONOKUCHI, CARL KAORU (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:KAORU
Last Name:JONOKUCHI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3901 LAS POSAS RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-1501
Mailing Address - Country:US
Mailing Address - Phone:805-918-4476
Mailing Address - Fax:805-918-4478
Practice Address - Street 1:3901 LAS POSAS RD
Practice Address - Street 2:SUITE 10
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-1501
Practice Address - Country:US
Practice Address - Phone:805-918-4476
Practice Address - Fax:805-918-4478
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2017-03-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG52095207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA93135Medicare UPIN