Provider Demographics
NPI:1578665667
Name:OHARA, JUN-ICHI (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JUN-ICHI
Middle Name:
Last Name:OHARA
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 ODYSSEY
Mailing Address - Street 2:SUITE 170A
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3195
Mailing Address - Country:US
Mailing Address - Phone:949-654-8963
Mailing Address - Fax:
Practice Address - Street 1:22 ODYSSEY
Practice Address - Street 2:SUITE 170A
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3195
Practice Address - Country:US
Practice Address - Phone:949-654-8963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAO53621A207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA53621AMedicare ID - Type Unspecified
CAF66265Medicare UPIN